Ep. 23: Implant Deep Dive Part 1 - Evidence-Driven Implant Design

Part 10:00

This is Beyond the Arches, where full-arch dentistry meets real talk. Let's get into it. Hello and welcome to Beyond the Arches. I'm your host, Dr. Daniel Noorthoek, and with me today I have Patrick, Wes, and Blake. Welcome, guys. I'm going to introduce you here. Blake is our new surgeon that's training at the Boca location. What's going on, Doc? I guess it's Dr. Hauer, but we've got Blake with us today talking about we're going to go through implant brands and different designs and generational changes and things. Most of that is because we've got Patrick here. Patrick, welcome to the podcast. We have Wes as well. Both are with an implant brand called SIN. SIN is based out of and manufactured in Brazil.

Headquarters is Scottsdale, Arizona. Headquarters is Scottsdale, Arizona. Wonderful. Patrick and I go way back. ▶He originally is the one that switched me over to Neodent. Then Wes, we have a connection with a different implant brand, BioHorizons. We're just a little dental crew over here, titanium crew. Just going to update everybody on the latest and the greatest. Absolutely. To start, let's go. We've had Blake on before. We've discussed things with him. Why don't we go through with each one of you and just kind of go introduce yourselves and let's talk about who you are and what your history is and all of that. Why don't we start with you, Wes?

Sure. Well, my name is Wes. I've been in the dental field for 12 years now, eight of those years with BioHorizons, three of those years with NEOS, and now here at SIN, for one year. Covered the state of Florida with all of those companies. So, have seen my fair share of implant dentistry and full arch and just kind of excited to chat about those things. I didn't know that you were with NEOS for a period of time.

Yeah. You said for three years? Yeah. Wow. Interesting. And what was your territory that you covered? My territory was the west coast of Florida. Okay. Interesting. Yeah. At least a few NEOS back in the day. Yeah. Awesome. Well, good to have you, Wes. Yeah. Thank you. And Patrick? Yes, indeed. Okay. Patrick Dewey. Been in the business since, what, 2006? I started as a sales rep in Northern California, covering pretty much the North Bay, Monterey Bay Peninsula, all the way up to even sometimes Walnut Creek, all the way over to the inner parts of California.

Um, did that for six years, selling implants in a surgical operatory, moved over, to, uh, Arizona as a regional manager, had a team of people selling implants, surgical, surgical selling, selling in operatories, uh, helping people use our products to grow their practice. I then resigned from Noble BioCare in September 15, 2015 to launch an opportunity, which is Neodent. And that's where you and I ran into each other. I was September 15, 2015, did that until May 29, 2020.

Part 23:29

So, uh, you know, I was in a company where good old Guillaume gave me the hack. It was actually Rob Woolley at the time, but, uh, they, you know, they, as most companies did, a lot of companies got a little bit scared during COVID. Nobody knew what the future looked like. Um, there's some expensive employees and countrywide and actually across the globe, they had to do some major cuts. I was one of those cuts, chose not to come back after an arm was extended months later.

I played tennis for a year, burned the non-compete and then came back and, uh, June 1st, 2021, I launched SIN360. SIN360 is, uh, basically, uh, a company that sells trains and supports on full mouth rehabilitation solutions. So CAD CAM software, a million software, we developed the Micromapper photogrammetry device, uh, in conjunction with Clarinav. Um, we sell, uh, million machines, 3d printers, uh, a full implant line. We've got a full remote anchorage line from pterygoids, zygomas, transnasal root form implants, you name it. So our goal is to live in the world of full mouth rehabilitation or digital implantology. And, and you've, you've, uh, I've always respected you in the field because you're always kind of like the next step ahead or not even the next step ahead, but you've always been current, right. Or been with, with the current trend and not in a, um, steer. Sometimes you can, you can get a company that, that steers you in the wrong direction or, or is maybe not in the best direction because it's the new product that just fits something else. And they found a guy to sell it to. And then you happen to be that guy and it goes down the wrong direction. Yeah. Everything I've ever done with you has been, you know, back and forth, but we've always, it's always advanced me more than any, any kind of put any kind of hindrance on me. You know, there's always been, there's always been some good stuff happening to me.

There's never been – you've never put a product in front of me that has ended up being something that got in my way. Yeah, that is your perspective. There is a number of perspectives out there that would say otherwise, and that's okay. But I say that is your perspective because you live in the world of full arch as well. Because of the obvious benefits that you see clinically from a patient benefit between – from a business benefit, there's so many benefits which we can go down those.

But I as well share that same philosophy. I used to say those people that know me would say, Patrick always says the full arch is where the party's at. That's where the action is. Yeah. Right? Because it is. I mean, it's life-changing for a patient. Huge. You can – most of these patients are dentally exhausted. They've been through multiple treatments, could be dating back all the way to their childhood. And this is a – This is a short-term solution as far as the treatment.

In your case, relatively, I mean, you can correct me, but I think it's seven to – Yeah, five, seven days. ▶But seven days of their life, they can completely put this behind them, be done, and have an amazing smile. They can function. They don't have to hide things. They don't have to share – you know, they can share a smile with anybody they want at any point in time, which for years most of these patients have not been able to do.

Or it could be as simple as function. Yeah. So I say that that's – That's your lens. There is a few doctors out there and clinicians and practices that don't feel the same way, but that's okay. For example, guided surgery, that's something where I deviated from the corporate path, still do to some degree. So, yeah, everybody's got – Which is something that we very much share together, for sure. Yeah. And we're getting Blake there as well, and we're working on it.

We saw him do a case today, and it looks pretty good. Oh, he's doing great.

Part 37:28

Exactly. Yeah. And for those of you that are listening that are patients and may not be in the dental industry, may say, well, why do I want to know – listen to this with an insider. And what's nice is with the perspective of the insiders, what I like to show or what we're kind of trying to accomplish here is that there's thought that goes into all of this. It's not all marketing. It's not all, you know, just an implant screw.

There's – Or who sells it. There's actually a discussion and a thought and a process behind every piece of the puzzle. There's a reason why we would use an implant. There's a certain thread pattern, which I'm sure we'll talk about a little bit. But there's specific reasons that bring this technology about that isn't just about jumping on the new hot thing. It's an actual change to the industry that provides a benefit either for long-term or ease of use, et cetera.

And so that's – I wanted to get you guys on this podcast because you have a good perspective on the way that the world works. But I also wanted to show a little bit of an inside view of how that interaction sort of develops, right? And so speaking of like how that interaction develops, how you and I met, I was with an implant company, the BioHorizons that Wes worked with that we weren't working with each other directly at the time.

But at that moment – At that moment, I thought I was doing pretty well. I did a lot of full arches and things were going pretty well and successful. ▶And Patrick came and completely changed my life for seven years or ten years. Now I'm not even sure. I don't remember when we switched. 2017, somewhere around there. Yeah. Maybe 18. That sounds about right. And what's cool is, you know, you kind of think that you have this world sort of.

Figured out and you say, well, this is the greatest way and this is the best screw that we can use. We should probably give – if there are patients listening, we should probably give them a little bit of philosophy on screws like the threads. Sure. And why they would be different because – and just a quick little analogy here is if somebody is going to go to Home Depot Race Hardware and they're going to put a shelf on their wall or – and maybe it's a metal shelf or maybe they're putting on a metal fence post or something.

There's different thread types. Depending on the material. So within dentistry, you've got different thread types that perform ideal in different places of the mouth or bone density. So if it's really hard dense bone, you're optimizing when you have a smaller thread pattern, less aggressive threads, takes more rotations to go in. Maybe it goes in a little bit slower compared to balsa wood or something really soft. On the other end of the extreme, you have to have some big threads and there are really big gaps in between the threads.

And the implant goes in, it goes down three to four times as much as the – a tight thread pattern. So on for each rotation. So just to give a little bit of a visual perspective, it's – Yeah. And to parlay on that, they're – each thread, if you think about it along a cylinder, each cutting surface, every part that's – if you think about a screw is also – not only is – they're a distinct use case for them, but if you think about it even more granular, there's also the different forces that are applied to that thread, right?

And so you've got really three big forces at hand. You have compression, which is up and down and pressured up and down on that screw. You have tensile, which is sort of holding it like from above, right? Or below. It's however you want to see. But it's – It's sort of like holding it basically from above. And then you have shearing, which is the force of it getting pulled away from the other surface. And so when you look at sort of the schematics of where that pressure does get dissipated across that thread surface, thread design to me is one that's very important.

And really was one of the main reasons why I was with BioHorizon, something that they do really well, is they have what's called a reverse buttress. And it really – It really dissipates a lot of the shearing and the tensile forces, which is sort of your most negative ones. It's the ones that you don't really love. And it kind of evens that out and then maximizes the compressive forces the way that it's designed. And so for me, I've always looked at an implant from a very macro design sort of perspective, which is I really care about the way that that thread's going to work and handle.

Now, the disadvantage – The disadvantage of it is that when you're trying to release it and reverse it, it's not the strongest and they have a few weak points in their connections, which is why I kind of worked away from them. But for me, like thread design has always been a big, like deep passion of mine. Like Blake can tell you, I talk about thread design and macro design quite a bit because it's something that I really am passionate about because it's really what you're hoping and praying that this implant works on.

You know, that's the primary. Not just the thread pattern, but you have to use whatever thread pattern you're sticking with in all of those cases, whether it's hard bone, soft bone, medium bone. So you need the best all-around technology. Yeah, you put it maybe a little bit slightly different way is when you're taking notes in a lecture, you might have a pencil and a highlighter and a Sharpie and you get to use all those in whatever scenario you want to.

But really in surgery, because of the way that parts and pieces fit together, you're really trying to fit the best pen that works, that kind of does all of it together. And that is a big thing as well, because you want it to sort of perform under all these conditions. And a person may say, well, why does that matter? I mean, why not just change it? Well, you don't want to make a big cluttery mess out of all these different, you know, you don't want to mix your name brand Legos.

With your Roblox, right? You want to make sure that those all work together and kind of have that standardized platform and that standardized screw that all works together. Yep. And clinically, depending on the procedure, too, and the outcome of that procedure, if you're trying to load those implants immediately or what the outcome is, that has a big play in the implant design as well and the threads on that. Yeah. The initial stability is so dependent on the initial tightness with which the implant goes.

Yeah, it's very important that that has a good design so that you have that initial stability. I think one thing to add, which I know SIN has and Neodent, is having one single platform I've seen in the office makes the ease of inventory for multi-units very straightforward and also just more predictable for what we're doing on the surgery end. Yeah, so for the people at home, you've got the outside that has the screw thread that holds the screw in.

And then what? What Jake is saying is that the inside is kind of the holding piece or the drywall screw. Inside of the drywall screw is where you're going to put the parts and pieces that attach. The abutment is what we call it. And sometimes you can get manufacturers that have varying, that maybe the outside is the same, but the inside changes depending on how big it is. But the overwhelming trend, and it's an amazing trend in full arch, is that all of those parts and pieces fit to a single.

And that has some biological principles that are important, which we don't need to get into, but it also has some ease of use scenarios where you can use it in this person and in this place, but you can also use it in a different and have just two or three parts in hand instead of 20 or 30. Yeah, 100%. Yeah, one platform for all diameters of implants, all types of implants. Was Neodent one of the first companies that was brought that?

Yeah. To a single platform? There was a few others, but Neodent was the first one to go main scale, at least in North America, where you have one platform. It doesn't matter if the external diameter of the implant is 3.5 or if it's 5, 6, 7 millimeters, it's the same exact connection, which makes, from an inventory perspective and from an ease of use while the patient's getting their restoration, having that same platform makes things so much smoother.

When you say that. They're the first ones to go mainstream with it or mainline with it. Are you sort of referencing that there were other people that figured out that if you put a smaller platform on a wider implant, that it heals better and it works and you can kind of have variable amounts? Yes, but here's what happens when you introduce that concept. Oh, there's, yeah, there's the platform switch. So there's a few companies that picked up on the platform switch.

They ran with it. But main scale, most large companies would not adapt it, regardless of the scientific evidence, regardless of what's best for the patient and the tissue response, because it cuts their revenue significantly. If you want to know the truth. I mean, there's most implant companies would acknowledge that, but then they would say, okay, we have to keep our revenue up because we've been selling X amount of abutments and parts that go on top of the implants the previous year.

We have to grow that. But if we shrink our, our inventory that goes on top of the implants by 50%, we're going to sell a lot less than we did the year before. So that's why the disruptor companies like Neodent come in and disrupt. ▶This is, they didn't have years and years of sales in the U.S. So they just started off with what was best for the patient, what's best for the clinician and kept it that way.

And that's how they sell our today. Same thing with SIN. When we launched in the U.S. One platform across the board for everything makes it simple, makes it easy, and it's what's best for the patient. I'm kind of speechless because I've never considered the fact that that sells more parts and pieces. Significant. Oh my goodness. Like you literally just exploded my brain. Yeah. So think about it. If you've got a, if you've got an abutment for a narrow platform, like at Noble BioCare.

Sure. Noble BioCare would have a 3.5 NP narrow platform. Then they would have a 4.0. Regular platform, different abutments completely. Then they would have a wide platform. Right. So there's triple the inventory you would need compared to like with what you did today. It's one platform. You can put one abutment in any implant in the mouth and it fits. Right. And I've, I don't know why I've ever considered it that way before, because I've got a couple boxes from old implant systems where I just have dead inventory because we don't use that system anymore.

And I just keep them on hand for if we ever need them in the future and they've been paid for, which is all dead revenue that went to them. Yep. Exactly. Yeah. My brain just got exploded. Um, well from, from the now moving forward side that, that generally everyone's kind of finally kind of come on board if they're a serious player in the game, because not just the simplicity of only having the one part and piece to, to fit on.

Um, but it also makes it biologically, it's better because, you know, for people at home, there's another concept where when you put an implant in and you put that piece in the abutment, uh, traditionally we were just hoping that it works talking traditionally like 30 years ago and the concern wasn't truly at what happens at the top. Well, if you think about it from a big perspective, you've, if, if it isn't a tight enough. Or if it just wrenches down with another screw, um, that has a little bit of a looseness to it and it can wiggle back and forth and that wiggling for, for patients can create bone loss at the top.

Right. And so that, that bone loss is a bad thing. We don't like that around implants. And so they combated it really by the industry has combated it really primarily by two ways. One is making the. Part that's moving around skinnier. So that's what we say when we say platform switching platform switching means, and if an implant is four millimeters wide, uh, and we would normally have a four millimeter wide abutment. Now we're going to make it 2.75, uh, abutment and four millimeters, still same four millimeter implant.

And so what that does is it moves that bacteria from moving back and forth and protects the bone at the top, right? So that's. Platform switching. When we say that the other part is that a lot of, and I'm actually, this is this, it's always astonishing to me when I look at other implant systems that come out and trendy ones and cheap ones and all of that are still using connections that are essentially flat to flat. So if you, if you, for those of you at home, if you're thinking about, um, a cup sitting on a surface of, of a table, it's when you.

When you wiggle it back and forth, it's going to have a little bit of a rattle to it, right? It's going to move up and down and move pretty easily. That's that same pump that we were just talking about on the rock, the cup. Yeah. You can rock it pretty easily back and forth. And one that leads to breaking because more things rattling in a car is not good. Um, and two, that also creates that bacteria pump that we were just talking about and bone loss as well.

As it rocks one way, you know, mucus and bacteria get underneath. Yeah. Yeah. And when it rocks the other way, it spews out, goes over the implant on the shoulder, down to the bone, and then the bone starts to run away bad day. And what does that phrase? They say, you say bone sets the tone, but tissue is the issue. So the bone runs away, then the tissue runs away. And then a patient's looking in the mirror and they see their implant parts.

Yup. And that's, and that can be a big problem. And so any good full arch system that I would ever even consider has what's called a conical system. And the conical system is really easy for people to understand. Cause the conical, a conical connection is essentially like, if you get two cups that are stuck together in the dishwasher, they have this tight. It's a, it's actually a, um, it comes from machining and lathing. It's, uh, called a Morris taper.

It's an actual calculation. I don't know what the calculation is offhand, but that perfect conical connection, uh, is meant to sort of replicate that tightness that you feel when you're trying to pull that cup outside of a cup. And that limits the amount of. Of that separation, that movement and reduces the amount of bone loss. So combining the moving on the inside, the platform switching and the cup inside of a cup concept is why we use the implants that we use.

We don't just use any willy nilly implant. And that was one of the main problems that I always found with other manufacturers. You'd say, listen, your screw threads are amazing. I love your people and I love your prototype and your protocol. And I love your. Your drills. I love everything about you, but I really need to protect that bone and I need to get a better connection there. And they'd say, wow, good point. And then, you know, nothing ever happens.

And it is astounding to me how many implant companies have sort of lagged behind. Now, most of them are coming together and incorporating some sort of conical connection and some sort of platform switching, but a lot of them are sort of retrofitting what they already have and calling it a conical connection. Cause. Any sort of taper counts as conical, but they're not following the rules that are the cold welding of the cup and the cup and that, that fires me up too, because you've got new period honest going through period school.

And if their director isn't preparing them correctly for, um, accurately looking at and discerning what's going on there, they just hear the word conical and even dentist to dentist can just get flipped right through. Cause it's not a. Concept that's really been pushed yet. Yeah. So, so if you think about it this way, you've got, um, technically I, I don't quote me on this. We could probably chat GPT pretty quick, but, um, from my recollection, anything lower than a 16 degree connection is considered Morris taper.

Um, the two main systems in the market now, SIN and neo dent, those are both 16 degrees. So the right at the cusp, anything over that, like there's the majority of systems out there. Uh. Um, are 22 degree conical connection, but they're really short, so they don't technically qualify and you'll still get the rocking because there may be an internal hex that's actually the butt joint connection, but there's a small area that there's a 22 millimeter or 22 degree connection and they call that a conical.

So exactly. I see what you're saying there. That makes, that drives me bananas. The downflow. So let's just give a quick understanding. So you've got the best connection in the world. Is probably from a, from a biological standpoint, from the body's response is probably going to be the bicon system because it's a six degree, right? It's almost parallel. And when you took fit two machine parts that are almost parallel, they cold fuse together. I mean, you're cold well together.

You can't get them apart. So from a biologic perspective, there's no rocking like that cup on the table. There's no bacteria getting in there. The problem is, is when a patient needs to have a replacement or repair. Or take the abutment to off, it's almost impossible to get off and there's no indexing. So if you do get it off and you want to put it back in the same position to put their teeth back on your kind of SOL.

Yeah. And for people at home, this, this system is kind of crazy. It's genius. Cause it, like you just said, it works really, really well from a actual, you know, biologics and mechanics standpoint, but this crazy system, do you know, like on Blake? Hey, these are short, wide implants, like posterior sites. Yeah. And you have, you know, like. Hammer, hammer them in and then you hammer the abutments in. It's not actually a screw. It's actually just the, the things that look like a screw on the x-ray just stick straight out their fins.

And then when that goes in after it's healed, there is no screw that goes on the inside of the implant. So it's just a post inside of a post is literally just a cup inside of a cup. And sometimes when they fall out, what, what Patrick is saying, sometimes when those fall out, like, uh, uh, they'll come, they'll come loose or whatnot. From. From chewing the, some of the instructions that I may have changed since then, but like 10 years ago, the instructions were to like, tell the patient, if you can get it approximately in that hole, like just take a cotton swab and bite down on it yourself to seat it.

Cause there's no screw that index it. They're going to do the exact same thing. What do they call like a friction grip? Yeah. It's, it's very friction. Yeah. It's a friction fit. Yeah. Crazy system. Cold weld is what it is. It's very popular in like Boston and up in the. Northeast. Right. It was, I, I, to be honest, I haven't ran into somebody who's in bike on in years.

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So I've only come across them a couple of times in practicality, like in terms of, um, use, you would take the impression they gave you a plastic, a plastic, uh, post that you would put in and take an impression with that because the plastic was retrievable and then you'd send it out and have the crown made. And then they would put it back in, like, they would give you a metal. One with the crown attached to it.

And then that's when you would insert it. But if you inserted it or they bit down wrong, you have a crooked tooth. Yeah. So we like screws in, in our industry. Um, and so walk me back. So let's, let's actually, let's move away from implants. Cause the, and, and by the way, uh, if you're a patient, um, need it has been amazing in terms of, uh, performance and function. And I have loved everything about there. Macro and micro design and the way that they've worked and they've been a great partnership for us, but just as a heads up, S I M three 60 just came out with a similar implant that kind of has crossed all of the thresholds and the bars of, of what I like to see in an implant.

And so we used it this morning in a surgery, Blake, actually, that was the first implants that he's placed in our center, which was kind of cool. Cause it's kind of funny. Cause it's, we're such a need at based system that he, uh, placed S I N S to start with, but now we can't go back. If you're a, if you're a patient, um, you know, don't be shocked. Like there, the, the point of this discussion is to understand that there's decisions that are made based on fundamentals that I, as the person that's charged with running this show, there are fundamentals.

I don't like to, uh, cross over or compromise once those are. Those thresholds are met, then all gloves are off. And so as a patient, if you get an S I N or if you get need, and I think we're getting to a point where we're really close, obviously we'll have to see some longevity and stuff, and we'll work that all out, but sort of trying to impress that it's not necessarily the brand commitment that should happen.

▶It's the person or the people or the committee that's deciding and working together to say, this is the appropriate implant for our patients to get the best clinical outcome. Not just the implant. Not just the implants, but, um, you, you've been in this field as I have for quite some time, but it's the implants, it's the workflow, it's the, the fact that you guys use photogrammetry. I mean, those are the important factors. It's understanding the holistic approach, how to put everything together and how to eliminate issues for the patient long-term.

And I think you guys do an exceptional job at that. Thank you. We, we work very hard at keeping systems and flows very consistent so that our patient experience is consistent. And, you know, it's really, I watched, I watched the clips on this, you know, podcast to be on the arches. And sometimes I think, man, out of context, it sounds really bad. Like you don't do any prep work beforehand, you know, and you just get this little clip about why I don't do any prep work beforehand.

Well, it's, it's not a one size fits all. Like every patient is unique. Every use case is unique. Everything is very unique to the patient. It's very customized, but getting order. And flow in that customization is very important and it's hard to kind of mix that super custom with super flow chart. Right. It's hard to communicate. I use this screw for everything and I use this screw for everything, but it's super custom. Yeah. You know? Yeah. Yeah.

What you guys do is it's, it's tailored. I think you told me earlier, you used the word more of a boutique where it's one-on-one with the patient and exactly what they want. That is very different from. From many others. I have no interest in building a, I have no interest in building a McDonald's.

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I respect McDonald's. I love McDonald's personally. It's one of my favorites. Um, but I respect them for what they do in their systems and their flow. But I'm saying it as like a, a cheap example. I'm not looking for just having 14,000 stores. I'm not looking for 1400 dental, you know, offices. One. I don't think I have enough hair to handle that, but for two, I want all of our patients to leave, no matter whether or not they are happy or it was too expensive, whatever the scenario is console.

▶I never want to have any of them leave without having a good experience. And that's the number one, most important thing for us. And if that means we get more centers, wonderful. And if it doesn't also wonderful, you know, I want that to be this very sort of small town feel, if you will. You know? I, maybe we end up as a roost, Chris, where you can get a really good quality, something for in many different locations.

Um, but we're very intentional about how we're going to grow this because I have opportunity to grow it as big as we want and put as many stores on the floor as you want, you know, in the state, in the United States. But that's not our goal. Our goal is to make it feel like, Hey, you're our buddy. We're making good decisions together. We're going to be for you in the long run. You know, we were talking about the lifetime.

I'm warranty. Those are the fundamentals that I really want to push forward on the industry. I think the patient experience is the number one thing is Patrick was saying a lot of these patients that you're seeing, they've been waiting for this for a long, long time. So this is a really, um, good, exciting moment in their life. And when you have procedures, like your practice has that your staff knows how to act and how to. Walk them through the process of getting them from where they were when they came into your office to leaving with a brand new set of teeth that they have fallen in love with the procedures that your staff knows and that you guys do surgically is second to none because everyone is going to be treated the same.

Everyone's going to go through the same procedures. Um, very boutique. It's not a big box store type of, um, one size fits all type of thing. And that comes like, um, Um, you know, you go into a lot of, uh, offices, uh, I use the Tampa and this is going to sound negative, but I'm going to use Tampa as an example. When we first purchased our office in Tampa, when we would walk in, there was an order of operation that was just very front.

Doesn't talk to the back. And the doctor makes all the decisions. We don't make a single decision without, and very intentionally, we try to grow our culture so that it's very shared experience. You know, I want my, um, janitor to feel justice. As much as an ownership of Dun and one is as, as I am right. And bringing that to the table and kind of doing that by example, that's why it takes us a little bit longer to develop an office and get it where it needs to go.

This is, I'm not just looking for an order of flow and people just walk around like robots. I want everyone to have that organic, like passion. Right. And so same thing with like with Blake, we're going to take a very intentional six months. Cause my hope for him is. Being that this is my particular office is to literally download my brain, but also to show him that there is no doctor talking down to an assistant, that there is no, that the front desk is just as valued in terms of, uh, opinion as, as mine is, et cetera.

And so that kind of comes with time and that's why it takes us a little bit longer to grow it. Cause we're being very intentional about how to grow. But, but when you get that, when you get that buy-in now, your office is impenetrable because there's not. There's not a single negative thing that can happen that we can't overcome. And one thing to add about, you know, the done in one brand, which is really valuable is that, you know, Dan and his team, they want to take the time to have a new hire, like me to have a training period, do cases with the entire team, get to a point where we all flow well.

Then Dan may build more in Tampa or Jacksonville, but you know, that's the true way of this company. They're not just trying to hire someone from day one who goes in and do surgery. And then Dan leaves, you know, he wants to build every location to be really boutique and great for the patient. And I really, you know, respect that a lot. And Blake, to finish that sort of topic on just culture, just on the way over here, when we were coming, you know, as we just said, Blake did his first full arch with us and, um, which is not his first full arch, by the way, but, um, his first full arch with us.

And, uh, he was just telling me as we were coming over here, how easy it was. Cause one, he's seen it a bunch, but Dean has done so many of those and we do it so similarly every single time that he's just the hands performing.

Part 636:28

And she's kind of almost like leading the dance of sort, not in a, um, she's in control of how it's going to go, but she's so in tune with it that it's just, you've, it just falls out of your hand as you go along because she's just boom, right there ahead of you the whole way. And that's, that's your assistant, right? Yeah. She's impeccable. Second to none. And Nadia, the restorative. The main restorative assistant. Now she used to be the same on the same plane.

She was my surgical assistant. Did you, do you remember Nadia when she was my surgical assistant? I don't know. Yeah. Uh, at Jules, my first surgical assistant for the first five or six years was Nadia. ▶She was equal, same plane as Dina and then decided that she really liked the restorative aspect and the more like changing upfront, changing the lives and the smile and the look. And so she went down the restorative path. Um, long story. Short came back and worked with us.

So she works now. Um, she wasn't in the room that we went and saw that patient, but she was in the other room. She works for us again. And then Dina came along and finally got to her. So, so walk us through what I walked into today because you showed me a, a first, it was a first look. Sure. First look, so to speak. I mean, uh, ladies teeth were gorgeous. She was crying in happiness. Uh, it was quite impactful.

Yeah. Yesterday. She had surgery. She had surgery yesterday afternoon. The most noticeable. The most notable thing about her and one of the main, I guess you didn't really know the backstory when I showed it to you, showed her to you, but, um, what's cool is people come in for this all different reasons. I mean, it can be, I need to chew or my wife wanted me to have this and she passed away five years from cancer and, you know, I'm ashamed of this, but I have to get this done for her.

Or, I mean, you name it, you literally, you name it. I have a big TV show that's coming up next week. And I've always. Hated these and I'm missing all my back teeth. I mean, every reason under the sun, but what's cool about this is a one size fits all more like, um, patternistic, as we were talking about with the inventory and the, and the implant screw design very similarly, it doesn't really matter what the background is.

So this lady, she had avoided doing this for years and years and years and was missing vast majority of her lower teeth uppers were just kind of in shambles. ▶And just wasn't willing to go through with anything because she wasn't, she was scared of that step of going from, um, teeth to no teeth and then no teeth. She was scared of continuing to go with no teeth, right? Cause there's no, really no ultimate guarantee and the whole surgery yesterday, right?

Blake, like she, like you got this vibe that she was just on edge that it was going to work or not work. Right. And the point being is that that was her deep seated. Fear that she had to overcome and I can't overcome all those fears for everyone, but seeing her kind of get over that is really cool because you're seeing it from, it can, and it's always obviously like the same, similar reaction. Cause we're all human and it's human emotion of relief, but it's cool to see the different background stories and attach it to that emotion.

So, you know, maybe they're too embarrassed to go to their best friend's wedding and you get to see them do it, or they were scared. At. To do this and actually take this. And they were living in fear of not getting implants and now they have it. And that's sort of that relief. So that's what you guys saw. That emotion was coming from this deep fear that she wasn't going to end up with teeth or she was going to end up in this worst scenario.

And so within 24 hours, she's in a better scenario. I mean, what's a better, what's a better feeling in the world? That's my favorite part about being in those surgeries. Yeah. Watching them. With their new smile, actually, like she said today, she hasn't smiled like she was smiling today in years and now she can go out, have confidence, you know, do many things that, you know, held her back from her true happiness. And it's just, that's my favorite part is just watching that emotion that's on their, on their face.

Part 740:40

It brings tears to my eyes when watching it cause it's so life changing. It is. I just love it. And that's, um, I won't say that it doesn't have. An effect on me anymore, but after doing the, you know, thousands of arches, it's a little bit more like I'm a little bit more tone deaf to it. Right. Cause I see it patternistically and it's not that it doesn't have an effect on me. It's really awesome. But that's my hope with Blake is that, and I make like a lot of comments, like I'm tired of it.

It's not that I'm tired of it. It's that I, I need to get out of the way to show the next group. I need to show, I want that to be more people get to experience it. Right. Um, and, and what's really exciting about where we're at now, and, and this is where we can kind of come back into the tech side is we're at a, we're at a point where the world's your oyster, right? When, when I started doing this, it was, uh, just better than a hope and a dream that it would go perfect.

And the patient will leave happy. It just, right. Is that a fair way to describe it? Fair assessment. I would say. We knew we were going to get. It threw it back in those days, 2015 to 2018. It's just how big of a team and how long is the day going to be? Yeah, it might be a full. Yes. And how, how much patients will the patient have to have, how much is that person willing to go through to get to the end result?

How much is that person willing to mortgage their house even to get to that point? You know, it was all a question of how much can that person tolerate and it's so exciting that we can. Put. A file or put, take a person, take their teeth out, put, you know, get the information from it and then put that in a computer and instantly stick out a version of teeth that will eventually become this well-accepted, beautiful set of teeth that they get to live with and then permanent, permanent, and then parlay that on top of it when you really are using the technology properly, you then have a platform to jump off of for them to stay in that state.

Yeah. And then you can, you can have that set of teeth for a really, really long time, if not the rest of their life. And you don't want to plan that these materials are going to fail, but it does exist in the universe. You know, like even bulletproof glass has a, has a stress point that breaks. No, I mean, somebody gets, I don't know, for example, they're playing catch with their, with their grandson and their grandson throws a baseball, hits them in the teeth and, you know, they break a, break some teeth off.

You're going to have to repair those. But with the digital file, what you're talking about, you can. We print those off within minutes. You can remill it with a CNC milling machine with subtractive manufacturing. There's, there's multiple ways to do it. When you have that digital file, the patient will have for the rest of their life. You can manufacture it in any material you want. That fact gets me up every single day because we're at the very, very beginning of this.

And it's just such a big game changer that really just brings just a ton of. Opportunity to the world, not just from a cost value, you know, basis for the patient, but for the dentist, and then just a longevity as well, you know, not only in a big extreme case of, of an, of an accident, but if a person loses an implant, that's the worst thing that can happen to a full arch patient, right? It's not a cavity.

It's not a broken tooth in the front of mostly, but it's not anything other than. An implant goes bad. That's the number one worst thing that can happen in a hybrid. Well, now if we have the files and the right equipment and the right workflow, you can get them back without it even being this big thing. You know, it's almost even less painful and less inconvenient than a filling. And that to me is earth shattering. That's exciting.

That, that is, that brings me energy and joy to be able to offer that and have that like, Hmm, it's going to be there no matter what. I feel that feeling. That you have, that you were just explaining that comes from the, the digital workflow and what we can do now in dentistry has opened the doors for clinicians to want to do more of these cases because of those things, because of the ease of them, because it's not a full day procedure because of the more predictability that it can be, which in the long run is a benefit for the, you know, society of patients that need this.

So it's a win. It's a win for both the patient and on the clinician side from what the digital workflow and the capabilities of that have done from just wanting to do more full large cases. Why don't we walk through that? Do you mind? Yeah. Real quick though. I'm going to jump in because you, when you were first working with, you've always been a bring the full end to end solution together. Not just when you, when you were with Strauman and Neodin, you weren't just a screw guy.

And then whatever happens happens. ▶You had the milling machines and you were, you've always been a, let's get the whole operation all the way around to the, to the table. And so in that note, there was, um, there was some meeting that we went to is when I first had met you, you used to give this talk that was set up on what part of the population needs this procedure and has access to it. Right. There's a, there's studies on that.

And you were the first time I had seen that because my, my education was mainly, was very hybrid deficient. We were into snap-ins and that's a whole nother couple episodes, but I had started doing hybrids and saw the need and the function in my area. And I thought it was, was as if we were fishing in a pond that had five, five fish. And when those five fish had gotten caught, whether you had three or two. It was done.

But in reality, when you look at the numbers, the pond is so vast and so deep, you can't get to the bottom of it. If you try, you know, competitors come and go, et cetera. But there is such a need in the patient base for this that have access to the, to the funds and, and need this care done that, that, that pond is really deep. And that was the first, when you gave that lecture, that was the first time I had seen those numbers.

Cause I had never really been exposed to that literature. And that completely. Changed my mind. That probably set one of the biggest trajectory switches in my career, because I S I thought to myself, that pond's really deep and really big. And those fish make more fish, you know, there's more, that's, there's more of a need in there than, than I could possibly get to in a hundred lifetimes. And that just before we get into like the workflow, that was one thing that really changed my mind was this isn't just five, five fish in a pond and we're all fishing for it.

So competition comes and goes, they want to come in and they want to train with me. That's fine. There's more of them out there, you know? And that's, that's what really kind of changed my mind was that, that lecture. Sorry. Yeah. The, the full arch market, as I mentioned in the beginning of the podcast, it's, you know, I used to refer to it as that's where the party's at. That is not changing. It's only increasing with adoption, with use, with history.

So published articles, there's more and more science being done here. There's more technologies, which we'll get into. Just a sec. But most importantly, there's more availability to patients across the country and at better price points with faster technology. So everything's only becoming at a, it's coming at a higher cadence and it's happening more and more everywhere. So it's. It's fun to see. It is great to see. No, I love it. Yeah. And I love the longevity being there and the available bone and sort of the, the technology.

The technology has kept up with where we want it to go pretty well.

Part 848:50

And so all the naysayers that we had to overcome through the beginning years of when I was doing hybrids and you're just sort of a pariah at the meetings of he's one of those lunatics that does full arch. Like you're going to have to come on board at some point, pal. You know, maybe they have come on board. Maybe they haven't. But it's the, the entire industry is fully come on board because they realize like, okay, you can, they're only going to paint themselves in the corner.

For so long. Yeah. The, yeah. The phrases of all on fours, none on three and, and we can go on and on, but you look back and it's like, okay, you know, the full arch is. It is all on four, none on three, but you just add one and take your digital file and add it to the file and put it back in. But they were searching for a way not to have to go out of their comfort zone is what it is.

Yeah. So you were one of those early adopters that, that committed to making a change because you saw it, you saw the outcome, the results you saw where this could go. And how patients lives could be changed on this with this procedure. I got lucky. I got lucky because of the opportunities I was given right away and the people I was fortunate enough to meet along the way that formed my, my help me form my opinion on my own and, and correlate that with the clinical results.

Yeah. Before we jump into the technology, I wanted to ask Blake a question. So when we were talking about the conical connection and that tight, intimate fit, do you know one of the. Most, um, prolific and groundbreaking people that the, the, the most, um, what do I say? Pioneer in the research of that micro gap and, um, the flexure and the, the use of that conical connection. Do you know that the biggest, not the biggest name, but one of the biggest names in that research?

What comes up to me is an article by three I and Lazara. And what they talked about is like, you know, the platform. Switch how it was used by accident when they had the wrong components, but maybe you're referring to something else. So that's, that's before that's prior that's three. I was the big brand of implant that started with a platform squid, uh, switching and that, whoa, just a side story. When I was at VCU, we did three eye and we had these platforms switched implants.

▶And as a person that didn't know really what an implant screw was and how an abutment worked and all of this, you had colors and sizes. It was the most confusing thing I've ever been through because they would mix the size with the platform. And it was really hard to tell which one was, which as your first learning, then they drop encode on top of that. Yeah, I mean, yes, yes, so no, really what I was testing you on is your director.

Theo Katusa was one of the main guys with, uh, ankylos and with, um, Astra to do a lot of that groundbreaking research on the micro gap. Micrograph of the conical connection. Yeah. And close is one of the first in the U S to have the true conical connection and a cone Morris connection. They had a 11.5 degree connection. Uh, it was a great implant system. It was acquired by, by dense fly and a, they basically just shut it down.

Yeah. They kind of, that was at the same, well, just before they bought the Astra brand and kind of brought that under their umbrella, the ankylos system was a really popular, really good conical. Connection, but it was very difficult for the restorative dentist, basically the, the implant screw, because it had such a tight connection in the abutment, you could put it really subcrestal and that's the way that they wanted to you to put it so that it healed over top of right on top of that abutment and because of the differing depths of that, it made it very difficult to restore along with the steps and the pieces that they had.

It was hard for them to restore. And so it kind of got killed by ease. Used by the general dentist. It was loved by everyone, but it was tough to restore. Is that fair? Yeah, that is fair to say. I will say that the. Neotense system and the science system also share that, um, That, uh, clinical protocol where you can place at sub crustal, it's actually recommended as you know, um, but we share that difficulty in in basically communicating the transmu cosi or, or gingiva height, the tissue.

height from above the bone and above the implant communicating that location to the laboratory when they're separate now with your location you you guys have your own laboratory so everything's communicated directly and everybody's on the same page but we're also cheating though so what you're the difficult we might have the same difficulties if we were doing it a different way we're cheating because he and i are the ones manipulating the gum tissue to where we want it and so we're seeing we're putting all the legos back while we're seeing everything get built and so we're building it and altering it the way that we want versus when you have a case that's healed and underneath the gum tissue that can be a big headache and i would i would tell you that we would struggle at that because it's tough because you don't have any reference point and you guys are controlling everything yeah and a lot of other places there's a surgical team that does the surgery restorative team that does the restorative and puts the teeth on and then the third party is the lab that's separate from both of them so yeah there's so much communication and uh it gets very difficult i did pull up some facts here i wanted to share okay so according to the american college of prosthodontists 120 million americans are missing at least one tooth currently the uh that's what one third the total population is like 360 or something somewhere around there yep they also state that about 36 million americans are edentulous missing all their natural teeth uh about 11 10 yeah 10 yeah other sources cite somewhat higher numbers 178 million as far as missing at least one tooth or more but either way i mean even if it's just 120 million that's quite quite a bit the cdc reports that among adults age 65 and older 11.4 percent have lost all their teeth and that missing teeth counts as that so each time they age each year that they age they lose more teeth so it's it's a prevalent problem and as patients are living the americans are living longer and longer their teeth are not sustaining that life and it's very common for teeth to have to be replaced and and on that note there were two there's two big numbers that i remember from you 48 million people in the united states have the income level to afford financing and access to the financing and also at the same time are missing we'll say 50 i don't remember that exact number but it was 48 million currently or at the time were in that umbrella of need it and can't afford it too um the other factor that was interesting was if on on average and you you definitely presented this in that last slide but i think it's a very important factor and i think it's a very important factor and i think it's a very important factor and i think it's a very important 49 arches there there are 49 arches that need to be pitched on full arch or need some sort of full arch type of um restoration in every and your average 2000 or so patient office so every time i actually go into an office and we look at buying it i'm considering okay 2000 not that it's a like i said we're not pushing it on the dentist's office we're not pushing it on the dentist's office we're not pushing it on the dentist's office we're not pushing it on the dentist's office we're not pushing it on the dentist's office that's there um but i'm also considering in my math okay on average when i teach them and i show them the way that this can be simple and easy there's about at least 30 of them that are going to be there and pitched and access to because that's a big number you take you throw a stone and you can find a 2000 patient office here right just down the road and if there's 49 arches there that haven't heard about it or need some sort of full arch work that's huge it is huge yeah and there's still a number that are still on there and i think it's a very important factor and i think it's a couch that don't actively go into clinicians or a local dentist to see their just for you know cleanings for routine checkups they just don't go in yeah and a lot of that's just more than the overall aesthetics of everything it has how much to do with your oral hygiene has to do with your overall health of your body yeah look feel yeah yeah let's go ahead and put a pin in this we're going to do a two-part on this okay so let's go i want to talk about additive and subtractive nurturing so let's do that in in another episode that we'll do the next week so or we'll do now but um if you're watching and listening like subscribe um appreciate you guys coming on we'll be right back on with uh with uh our crew here and um you know we'll we'll finish up part two talking more about technology but i appreciate you guys coming in and talking today thanks dan thank you