Ep. 10: How We Treatment Plan Full-Arch

Part 10:00

This is Podpopuli, podcast for the people. Hello and welcome to another episode of Beyond the Arches. I'm your host, Dr. Daniel Noorthoek. With me today, I have our beautiful Erica Pullen. Thank you, thank you. Excited to be here. Welcome. And the reason why we have Erica here today is because we're going to be talking about how I treatment plan, how we treatment plan, how do we get information ahead of time. This is sort of the beginning of a next segment of episodes in the next couple of weeks.

We're going to be going over just essentially sort of stepwise how we treatment plan, how we consult, how we make decisions, how we make teeth, how we put them in, all of the things that go into creating a case for us. We're going to be talking about more specifically, like in depth, kind of breaking it down. This will be a little bit of a segment of, I think it's six or seven episodes. Where we're kind of talking about it.

So starting at the beginning is where we're going to start, which is treatment planning. And you're intimately involved with the treatment planning, with talking to patients and working with them and getting them sort of to the home stretch. Absolutely. And so, you know, where we start is generally getting the patient in, right? Getting the patient to a consult. And so, Erica, you are sort of that first face, right? You're not the first. You're not the first voice they hear because we talk to the other.

Alex. Alex. They talk to the people on the phones. But you're the sort of the first face that they'll generally see either via Zoom or in person. Right. And a lot of times when I get patient or friends, actually, other periodontists that I'm talking to will ask me questions like, how do you do a Zoom consult? How is that even possible? So, you know, is it possible? How does it work, Erica? Absolutely. Absolutely. It's very possible in our eyes.

Our patients get set up. First, they have their initial point of contact. They get set for their Zoom consultation with us. And it's super exciting. It's honestly as easy as having an in-person consultation. We go through our process with them. We introduce both of our doctors. We have obviously Dr. Daniel Noorthoek, our surgeon. We have our other awesome restorative doctors. So we kind of explain it while he goes below the gum line. So anything as far as surgical extractions, implant.

Placement, he is your expert as far as she goes. She is going to be your expert as far as aesthetics, looks, as far as aesthetics, looks, the feel, the comfort, functionality, making sure that you're able to, you know, live your life just as you normally would. It's nothing, nothing outside of the normal. And we have sort of it's sort of like that. There's like a cheat code almost of when we get to see a patient. Either in person or on Zoom, you know, many times this dentistry would not be possible doing Zoom consults and doing things the way that we do.

One of the things that we do that's very important to us is generally speaking, we don't put them in a chair. Right. And that could seem a little cavalier and crazy and scary. But for the most part, what I found through the 13 years I've been doing this is that patients that need for large patients. That need full set replacement generally kind of can identify that they need that right there. It doesn't take them a doctor in a white coat with models and impression and poking around in their gums to figure out that those teeth need to come out.

And so what's nice and what I call it a cheat code is two things. One, we can have a conversation with them via Zoom and you can pretty much confirm that that that needs to happen. But two. We get to create an environment where there's really no judgment. Right. And so you're sort of that first person. You're the you're the smile, that sort of judgment free zone. You know, I already kind of mentioned it, but we don't go poking around in the patient's mouth in the first time if they even if they do show up in person.

The reason for that is we're not here to make patients feel bad. ▶They already know that their teeth need to come out. They've already done the majority of the research. This has kind of gotten past the tipping point. Now, this would be separate and different if I was doing consults for patients that needed a filling. Right. I can't diagnose or tell if they need a filling sometimes even when you're in the mouth. Right. Sometimes it's difficult to discern that this is a much bigger, different thing.

And so what's great is patients will generally either come in with some knowledge or without knowledge. But this is this generally being the consult is a opportunity for us.

Part 24:59

To kind of almost like sitting in a living room or having this conversation. It's about the same size room and we try to make it comfortable and warm. You know, personality is part of that, but also sort of the aesthetics. Right. We have carpet. It's quiet. It's it's kind of warm and sort of comfort feeling. Yeah. And in that way, we get to have a very like one on one conversation with them. Yeah, it's it's something that's very personable.

I think it's almost not. Even like selling any sort of product, it's essentially introducing our team. I always like to tell everybody that, you know, it's a huge procedure mentally, financially, physically. So the most important part of it is that this is your journey and we are part of it and we are here for you. So we want them to feel comfortable no matter where they go. Honestly, whether it be with us, anyone else, whatever it is, it's we want to make sure that they leave us feeling confident.

So before we get in, get beyond that first introduction. I'm a patient. I make appointment with any clinic, right? This doesn't all have to be done in one. What are the things that I should have as a potential patient of an office that makes Erica's life easier or makes my consult go better because Erica has an easier job? What can I bring to the table for you? The easiest thing to do is honestly just research. We have an awesome Facebook Facebook group that we always suggest because it's not just us telling the story.

It's other patients on there that are explaining their experience. So we can tell you as much as we can tell you from our point of view, but we are not the patients. So I think having more information is always the best thing. You know, never obviously stop learning in any situation. But the more knowledge that you have going into something, the more prepared that you will be. And I think probably one thing that's a little bit of a preconceived notion is they probably if you're listening to this and are thinking that.

I would think that I need to have my finances ready. And I feel like most of that financial work and tying up those loose ends really kind of comes after that first visit, more or less. I mean, very few people come and say, I have a check or have this ready or I have this bank scenario. Most patients, you're kind of going to be the one that guides them through after you've made the contact. Is that correct?

Absolutely. I mean, granted, it's amazing when everything's all dialed in. And ready because it kind of kicks out one of the most awkward parts of the conversation, which is you're going to be buying a new car. Yeah. But I think that we should dispel that. Right. That the vast, vast majority don't necessarily know exactly how much it costs necessarily or maybe have those finances lined up perfectly. Yeah. Is that fair to say? Very fair to say. If you had to put a number on it, like what percent do you think that would be?

I don't know. That have it ready to go or don't. I would say probably it's a good 50-50, honestly, because it's something that either patients have been looking into and saving up for several, several years because it's something that they've known that they want to have done for a very long time. We've had patients that have explained to us, you know, I had to wait until my children were out of college before I could put myself first.

And now it's my time and I am ready for it. And then on the other hand, there are some patients that are like, I don't know what's going to happen, but we're going to try. So I think, you know, with everything, as long as you're trying to and you can go on and we have a bunch of awesome financing companies that we work with. Yeah. One of the funniest things or craziest things when I was first starting to do these bigger cases, and it wasn't even a full arch case, actually.

It was, I think, just a lot of general dentistry. But it happened maybe three or four months after I had been out of school and was working in the practice that I was in Jacksonville. And there was a story that. This guy came in with $17,000 and it was all kind of smashed up. We'll call it in a shoebox. I think it was actually in a Crown Royal bag, but he it was in a shoebox. He comes in at $17,000 and he said, I've been watching your commercials and your infomercial for years.

I knew I was going to see you. I've never been here before. I knew it was going to cost a lot of money. So I'm ready. Awesome. And that that always resonated with me. The power of the long. Standing marketing and the long standing sort of brand. And you never know who this is going to reach. Right. This episode could be listened to by our future patient from six years from now. And they listen to it tomorrow or next week or whenever it comes out.

And that's that's always kind of wild to me that there's somebody out there for sure. Or a group of people that are listening to this that are going to be our patients that know and follow us. Oh, yeah. But but. Are trying to get everything in a row. And part of this conversation is you don't necessarily have to be that prepared or you don't necessarily have to be in that sort of fashion. We can help you along the way.

And it's always good to make the plans to begin with. But that always hit me as something pretty wild that you never know who you've reached. ▶You never know who's going to come in the door tomorrow. That's been following you for years or saving up for years or whatever it may be. And. And it varies. Right. There's that guy who waited years and years for it.

Part 310:34

And then there's the person who got an inheritance, called us and said, I need to see you next week. And we're like, hey, maybe you don't need to see us next week. That's that's OK. We can go further out. And she was no, I'm going to spend this. I'm a waste this money. I need to spend this on teeth. And if I get any further out from next week, I'm going to spend it and waste it. I know myself well enough.

I'm going to come in. So we have everybody all in between. And we have plenty of people that maybe they don't get accepted in the very beginning. Maybe we just take out a few teeth for them. We're very we try to be very understanding. Generally speaking, we'll take out several teeth that need to be taken out. We kind of go with the goodwill of, you know, when you when you get this done, it'll all get right. What goes around comes around kind of thing.

It'll all come together in the end. And unfortunately, finances have to be a big part of the initial. Financial financing conversation has to be the initial treatment coordinating conversation. I thank God every day I have you and Lilia and Vanessa and the team of treatment coordinators because it is awkward. It is a huge expense. But luckily, you're around it every day. You're used to talking about it. And this isn't something that just totally catches anybody by shock.

I mean, when we're advertising for full arch, that's what we're trying to get is the people that understand that this is going to cost a lot of money. It's not like they came in for a filling for the free cleaning and we hit them with a $40,000, $30,000 bill. So there's that part in terms of diagnosing, you know, when I actually get to see a patient clinically, we can make a lot of the plans ahead of time.

Right. So generally speaking, we'll get an X-ray of some sort, either it be a CT or in person. Obviously, this is much easier. But we'll generally get some. X-ray from a patient, either they'll go to an office and get the record or they'll already have one or something to the to the nature of giving me an idea or Dr. Lacks, both of us, an idea of how the teeth sit in the bone and what kind of bone is available.

And when you do this so many times, you can look at that X-ray and you can say, well, this is going to be great. This will be very straightforward, et cetera. I can. Get an appreciation for how much bone is there, especially if there's teeth. The only thing that gets a little bit funny, and you know, this is when a patient has an denture for a long time. Yes. Treatment planning a denture from far away is difficult because it's hard for me to discern whether or not there's enough bone width there.

Right. I can see if there's enough height to do a straightforward case, but I generally can't see a width scenario. Now, this kind of goes into where I think people don't understand is we work very much off of we're going to get you to the end product no matter what. So here's the extra steps that will get you there. Generally, we don't make it there. Generally, we don't go down this route. But here's the two avenues that we might go.

Say this person is in Washington, D.C., we'll say. Right. And you're going to come on a hope or on a promise that when I go into surgery, that's generally where I'm making my decisions. And people are going to hear this. Some people are going to hear this wrong. I don't do a lot of work ahead of time off of the x-rays and off of the clinical stuff and off of a lot of the things in there. My surgery flows based on what actual bone is there and what is going to be the best decision.

For that patient in that moment. One of the things that I rely on heavily is I was trained in a very foundational surgical basics in terms of skills. And I rely on a lot of my surgical training to see structures and treat them appropriately with them in front of my face. I find that a CT is hard for my brain to manipulate. One. Two, it's very hard to make 100 percent decisions off of a CT because it's very hard to decide, is this bone strong enough or not?

Or when I take this tooth out, will this break off? Right. You don't know those kind of things. ▶And so treatment planning and treatment decisions in the surgery has always been one of my strengths. It's been something that I rely on as part of my flow. It's the way that I work. It's the way I operate.

Part 415:23

Right. But that caters nicely. Right. To what you have to deal with, which is, hey, Erica, this patient may need some grafting. We're going to do this type. I think of it as a play. We're going to run this play on this person and we're going to run this play on this person. And here's your percentages. And so that's something that you actually end up navigating, communicating quite frequently. Yes, absolutely. And it's kind of easy once it actually comes out.

And then the patients do understand what's kind of. Going on. But, you know, before the procedure, it's kind of like the unknown in some sort of way to the patient when we have to go and explain. And we're like, hey, because the patient's questioning, do I have enough bone? What is this going to look like? What is that going to look like? And we're kind of, hey, well, the doctor is going to, you know, obviously review everything while he's physically there in your mouth, because that's the best case scenario.

He is going to assess what he is working with, make the right call, make the right decision. And go from. From there, because sometimes it's it's difficult to say it right off of the CT at the initial consultation. We can we have an idea. But like you said, it's either we can go this route, but we may need to go this route. So we just try to prepare as much as possible for you to come out of that procedure and still have all of your work done, obviously properly.

And for me and our team, the best thing that we can have is the communication with the patient that they understand the different directions that it's going. There's lots of different scenarios where maybe we'll say, let's take the denture example. We'll say, hey, I think you have about a 15 percent chance of this different way that we'll end up treating you and how we're going to stage you. Eighty five percent. Well, it'll go normal. That 15 percent may be what they focus on.

Right. And it may not even happen. Fifteen percent of the time. I mean, it very, very rarely end up doing it. But. When they come to the office and know that I'm going to treat them as best as possible in the right way, it brings a mindset that there's an understanding there that allows me the freedom to treat them appropriately, allows me to not have to force something to happen. I already kind of told them the different directions it's going to go.

And for us, I think what's very different than traditional treatment planning techniques and and conventional wisdom is that. We are not afraid to just have an open conversation with the patient and say, hey, you're a real person. This may not go perfectly. So this is the alternative. But keeping those channels open is what makes your job easier. It makes my job easier. It makes the patient's experience better. And so I feel that it's important to have this podcast and this conversation to let people know that there's a reason behind the way that we treatment plan.

There's a reason why it may feel a little intangible and different than normal, but there's a there's a backing to it. There's a thought process behind it. Right. Absolutely. And and that freedom that I can wake up and show up to work and do surgery on a patient and know that they've already had that conversation with you. They've had that conversation with Dr. Lacks. They took the leap of faith and flew in from Idaho, wherever it may be, knowing that we're going to take care of them.

Freedom is a very strong, amazing bond. It's a it's a great way to practice. I mean, when I look at the way that we practice and the comfort and the friendships that I have with my patients, you know, I'm not here to make best friends with every single patient in the world. But if they want to have that friendship and that bond, it's amazing how we get to practice. Right. I don't have to be false. I don't have to keep anything from them.

I can be very open and straightforward with them. And, you know, if something goes wrong, that's we talk about it. And I say, you know, I didn't want this to happen, but this is what happened. And here's how we work through it. And here's how we get you to the end product. Sometimes that means adding more implants. Sometimes that means less. Sometimes that means it's separate surgery. Right. No one wants to hear that they might need separate surgery, but that's kind of where the chips fell.

And it's a great, amazing way to practice it. This. And it all came from my my the way that I wanted our practice to treatment plan, our practices to treatment plan always came from you would walk in the room. I used to wear a shirt and tie and I used to wear a white coat and you'd walk in and you'd immediately feel the pressure and the tension. And now you're in instantly talking about car dealership prices. And this is your Chevy and this is your Cadillac.

Good, better, best. You feel that tension. Puts up walls right in between you. And immediately, if something goes wrong or off of what you said, your patients, one, not even listening because the walls up immediately. And two, you're already on the hook if if anything goes wrong. So having that conversational sort of tone down, we've I've lost the tie. I've lost the button down shirt. I've lost the scrubs. I've lost the white coat for a very specific reason.

I want patients to feel comfortable and I want to be comfortable going to work. And so. ▶I always saw that the biggest problems and the hardest people to deal with and the biggest complications, if you will, always came from when a patient would go in to a consult with, say, a colleague of mine. And they had the stone models and they were showing them all about what is wrong and what needed to be fixed and all of it.

I look at that. Right. But that treatment plan. To me, isn't necessarily for the patient. Unless it's an education thing. Right. I think I'll be able to get your jaw back to normal. I think I'm going to take this out. This would be amazing if we can do this. Would you mind if I do that?

Part 521:35

Those that's the type of conversation I want to have rather than you have 16 millimeters of bone here and four over here. Patients just glaze over. They don't want to see it and they don't want to hear it. Now, there's a subset that feel great when you put up a CT on the screen and you say this. And 17. Feet is where I'm going to put your implant. Great. Fine. But that doesn't change the hands. It doesn't change the experience of the surgery.

All it does is make the person more ready to get rid of their money or not. Right. And so for me, making the decision in the in the moment is one of the biggest sort of differentiators I think that I have versus a lot of my colleagues in terms of treatment planning. Now. Most of these patients. Patients are straightforward. Most of these patients we can tell right away what needs to happen. That being said, as I've been treatment planning these cases for years, I have gotten to a point where I can more or less get a gist of the patient and what they want and have a conversation with them.

And where we think you've probably heard it a million times is. Is. This decision is yours and yours alone. I'm here to provide you with education of what I would do for my own family. The good, the bad, the indifferent. And once you have that information, you can go to see me. You can go to see somebody else. You cannot do any of this. It doesn't matter necessarily. I'm just here to educate you. And you're part of that education, right?

Right. I tell you what I think, et cetera. If a person really wants it, maybe they're on the edge of whether or not they're going to be able to do it. Not they need it. Well, I'll say that to you. And I'll say, listen, like, let this person make their decision. Encourage them to go to a second opinion. Really, we want that decision to be totally 100 percent their own educated decision, their own. They own that decision because they knew the information that we wanted to give them.

And they made it. Absolutely. And the way that I used to make that decision and still do now to a certain point. Is. I used to go through and number the teeth because we're talking about treatment planning. I'll talk about, like, the way that I used to sort of make this decision and anything that needed an implant. Or was missing a tooth already. Needed a root canal and a crown or had something majorly cosmetic or positionally wrong.

Like a parent really bad. I would give it sort of we'll call it a strike. OK. And since we're replacing 12 teeth, first molar to first molar, I would break it into arches and I would I would give them a score out of 12 in my head. Right. I wouldn't necessarily review this with a patient, but. What I like about that system. And so I would give them a score. Let's say they were a four out of 12.

Right. Meaning four, four of their teeth had something majorly wrong, but eight of them were fine. Well, a four was not in my wheelhouse of ethics. Four. Four was not going to fly. I wasn't really going to give them that option, but maybe a seven, maybe an eight. Right. And I started what I liked about this system was when I started doing these cases on the regular, I needed some sort of guide that said, this is kind of when you bring out the conversation of replacing a full set of teeth.

And we'll say that in the beginning, I started when it was eight out of 12. Right. They got an eight out of 12 score. Sixty six percent was bad in this scenario. For them. This is when I talked to them. Right. And maybe through the years I saw how successful it was and I dropped down to seven and six. Right. And I'm probably one of the more aggressive treatment planners in the country because I have so much confidence to the results that we'll be able to get and how we'll be able to get it.

But I just wanted to provide that like little bit of insight. So we are thinking about things. But in full arch, it's a lot more global. It's a lot more patient based. It's a lot more global decision. Right. ▶You don't have to take out a full set of teeth. If a patient has a score of four out of 12 and they want four implants, that's fine. Yeah. Right. But that was when you wouldn't make a solid decision off of that.

That was when the suggestions started to come. Right. And so maybe you say at six out of 12 this this year, seven out of 12 is going to be my score. Right. Seven out of 12 is when I mention it. Here's your implant option with some bridges and some crown and bridge. And some regular dentistry stuff. But I also bring in full arch. Right. The advantage for us now is that used to be the way that I would treatment plan when I worked in a group setting that had everything.

It didn't necessarily cater to full arch. That was when we were dealing with trying to figure out pitching both things to them. Now it's very simple because. A hundred percent of the patients that come to us. Come for full arch. They already know that that's all we do. They've already mostly been told that that's what they need. So now it's a little bit of cheating. But in the old days when I was treatment planning, this was part of the decision making.

Right. And making a decision. You can you can say speak more to kind of how personal this decision is. It's a very big, very personal decision just for a patient to come open up and sit. In the dental chair or not even the dental chair, sit in our consult room or sit in a Zoom with us is a huge leap. Right. And you see. You get to see what's cool is you get to see the change from the very, very, very, very beginning to the very, very, very end.

Because also another one that we'll talk about in a different episode is the lifetime warranty. Eric is our captain for the lifetime warranty program. And so we'll bring that in. But you really get to see end to end apart from answering the phone calls on the first day. So you see how big of a leap that is and how personal of a journey this is. And I just never felt like if this patient's already self-selected, if I can tell if they have enough bone to get a predictable surgery and safe, good, repeatable results.

Why am I going to bring them in and stab them immediately or require before I give them a treatment plan? That I needed to stab them and see them in person. That never made any sense to me. This is a different type of patient. And being a different type of patient, you know, you have to treat them differently. I have three dogs. I don't have any kids, but I have three dogs. I have to treat and train and work with each one of them differently because they're different.

Right. Kids, I'm sure, are the same way. Employees are very much the same way. You have to treat them appropriately. And the full arch patient base, they don't want to see you. They don't want to be stabbed. That's the reason why they haven't been in. They're ashamed of what they have. And so providing that comfort and that friendship is very vital, I think. I agree. I agree completely. Giving them the information is a big part, right?

Part 629:08

And so we're going to reaffirm them from an education standpoint, from the doctor's standpoint of this is how many implants I think we're going to do. This is how I think. This is how I think it's going to go. The stuff that we've talked about so far. But then there's the other aspect, which is a lot of what you do, which is going to be here's the paperwork. Here's this. If you have any questions. So go through, walk me through how you handle, let's just say, the three-month diet.

That's something that we talk about quite a bit. That's a softer diet. Tell me about how that goes from both you in person to reaffirming it. And. And paperwork and like, how do you walk a patient through that information? So we walk the patient through that information. Kind of the first step is just making sure that they understand the importance of it, the importance of your implant integration, because we want this procedure to be successful for you.

And the way that that's going to work is you have to accept it first. Our soft food diet is just anything basically softer than a hot dog or anything that you can easily. Cut with the side of a plastic fork. So I like to tell patients you are not limited to just eating soups for the next 90 days. You just have to get creative with it. Anything you can toss onto the stove, kind of let it go all day long, which sometimes are the best meals anyways.

So that's what you're going to want to stick with. So we reiterate that pretty much through the whole way through the consultation, as well as just the process of being in the office. It's in a ton of our paperwork and we do follow up with it. It's we want this to work for you. So that's the first step. And the way in which you present it is important to write. You want to prevent presented in this friendly manner, but also professional and clean.

Yes. As you know, actually, what is my number one pet peeve as it relates to treatment planning and giving over paperwork? Number one thing, do you know? I don't know. Do I do it? Yes, you do. What do we not do with the. The instructions we don't copy them on a copier, right? Yes. So all of them are printed on color correctly from the file. Yes. One of the things that always drove me bananas was working in an office that this is the most important diet.

You have to follow these rules. You have to follow this three month diet. It's the most important thing. So you're giving the patient a signal. This is the most important thing. But then we would give them a sheet of paper that had been copied. About seventy two hundred times, you could see where they had whited things out in previous. Maybe they added as post-it note. It slid off to the side over time, right? Yes. Like, I'm not crazy.

This is one of my pet peeves, right? Yes. It's part of the most important information. But if you don't treat it as such, it might just be overlooked. Right. As we've learned, it's it's pretty common to get handed, you know, twenty five pieces of paper because we have a lot of general consent forms, of course. And they just easily get signed. And tossed out because you're not actually reading what's going on. So definitely the way that we like to do it is verbally.

We touch on the self-food diet a lot in the consultation. It's honestly one of the first things that I do go over because I want to enforce that. It's it's important. Yeah. I think that for treatment planning, you know, it's important to know that your. Care team will say your professionals, the people that you choose are on top of their team. They're game. That's the first thing you want to choose. ▶If you're choosing a team or a procedure of any sort, be it facelift or teeth or hair transplant, whatever it is, you want your team to be the best in the in the world.

Right. But second, you want them to have a good. Communication pathway that allows you to feel comfortable and solid in that decision. Right. As an example, my wife just went to a doctor this week and she loved the doctor, but she waited for him in the waiting room for an hour and a half or an hour and forty five minutes. The staff was rude. The paperwork was a mess. Right. And so you have to send all of these signals have to come together at the right time.

Right. She's now looking for another doctor. Right. Well, this one might have been the most amazing. Best hands. Best hands in the whole world. But they didn't have control enough of their system to get it right. And so bringing that whole team together is of absolute imperative, vital importance and getting that information correctly. I would say that the majority of what we try to do unique, fun and clear is finding new ways to provide information to educate the patient for them to take care of this.

Understand the importance, know where their payments come out of all of those different things, because that really leads to the success of their treatment. And so treatment planning for us is a whole lot less of the well, I'm going to get you the doctor and we're going to pour up the models and we're going to put it on a fancy machine and we're going to show you your x-rays on the screen because that doesn't really change anything.

I'm going to still treat you as best I can. And amazingly, I'm going to do a very good job and I know that the team will, but let's spend some time working you through the hard parts, the psychological aspect. ▶Why is this great?

Why is it? Why are you going to get good results? Why does this work? How does it work? What do you need to do to take care of it? That's the important part of treatment planning is is educating the patient to me. Treatment planning from Dan's side, from surgery side, from Blake's side. From any of the people that are going to be working, that's sort of just professional technique and preference, but it does come down to what's nice and we kind of rely on this a lot.

It's all I do when I wake up. This is what I eat, sleep and breathe. And so what I see as a very easy case is going to come with maybe it is complex for someone else, but I've already done it a bazillion times.

Part 735:48

I know how to do it well. And I think back to sort of woodworking when I think of this. I have a CNC at home, right? Do you know what a CNC is? I do not. So a CNC, you program the computer essentially software to cut, to move the machine in a certain way that it cuts the wood. Okay. So there are three different directions you can move in a router, like a home level router. For woodworking, it goes forward and backward, left and right, up and down.

Okay. And so the series of instructions tells the router, which is cutting the wood, left, right, forward, back, up, down, what to do. Okay. And when you're first programming this, you can program very complex cuts and designs and things like that. But executing it may be very difficult. Because you forgot. You forgot that the machine didn't know where the bit was, right? It didn't touch the pad correctly, right? ▶And so as you do this, and I've been doing it pretty seriously for about two years now, I did something yesterday on the CNC that I look back and there's no way I could have accomplished it a year and a half, two years ago.

Not because I didn't have the skills. Not because I didn't have the machine. But because I hadn't put all of the pieces. I hadn't put all of the pieces together, right? Independently, I had the skills. And I did already have that same machine. I haven't switched machines. But learning the hard knocks and going through the repetitions is what led me to being able to do it in an efficient sort of manufacturing type process that allowed me to cut out the bad things that happen.

And that's something we've already pressed on before is, are there complications? Yes. But it's how you manage them. It's how you treat them and how you and your patient are going to work together, right? Are there complications when I'm CNC routing on the milling machine? Absolutely. But I learn from that, move on, and then I've gotten better, right? And the more CNC routing I do, the better, more pretty, beautiful, well-executed, tight tolerance, whatever you want to say, woodworking I'm able to accomplish on it.

And so I see this as very similar where repeated times at bat. At bat, repeated times cutting into the wood, repeated consults that you do, you just get better and you get more comfortable. And having that team and being able to treatment plan in a way that's allowing the patient to be educated but not scared and be able to move forward with this part of their life is a very important thing. I agree. And, you know, it's very rewarding.

Extremely. It's been fun for me because, Erica, we got you. And you were really good. You were really green behind the ears. And just like Lilia, you started with scanning cases or scanning, not cases, scanning documents in, all the records. And we've kind of molded you and moved you into different roles and that you've excelled at. But it's been fun to see that because now you're kind of intimately involved in the fun part of it, right? You kind of did your time in the not fun part.

But, you know, and it is rewarding seeing a patient. ▶Two years back, three years back, four years back, still smiling. Oh, I need a little bit of a bite adjustment or I'm having a problem with this getting stuck or whatever it is. But it's rewarding seeing that long term.

Part 839:30

And I think that that's another aspect of hybrid dentistry that's lost, which we'll get into with a lifetime warranty, but keeping that connection. Keeping the connection in hybrid dentistry is really, really important. We all know it's important, but it's not done very well at all. And so we've tried to kind of break those barriers down as well. And we'll talk about that, I'm sure, soon. But in general, that's how we treatment plan. I appreciate you being here to discuss with us how that stuff goes down.

But so step one, treatment plan, consult. We talk. We go through the costs and the things to watch out for and the good and the bad and the ugly. And then next, we'll probably walk through. I think it's surgery. But this will be a. Segment of, like I said, six or seven episodes where we kind of walk through the different steps of how a patient's experience would go and sort of try to provide a little bit more of a back a back room type perspective to things.

And so appreciate you listening. Like and subscribe. Keep listening. We appreciate everyone that contributes, listens, follows, send questions in either through our Facebook group or through email. And. Robert had given us that email and I forgot what it is. So. But we'll get it. ▶As always, this is just opinions. This is just the way that we practice. You don't have to like them. You don't have to follow them. This is just the way that we see the world.

And so, Erica, I really appreciate you coming and bouncing those things around with me. And thank you. Thank you for having me. We will see you again soon. Thank you very much.