Ep. 52: Refresh Cases: Rebuilding Full-Arch Cases — Part 2

Part 10:00

This is Beyond the Arches, where full-arch dentistry meets real talk. Let's get into it. Hello and welcome back to Beyond the Arches. My name is Erica and today I am joined with Dr. Daniel Noorthoek. Hello. And Dr. Sarah Laks. Hello. Hi guys. So on today's episode we are doing our, this is kind of our two-parter of our refresh. And last time we spoke about kind of what a refresh case is, how we decide to take them on, and just kind of all the logistics that really go into it on our side.

So just in case if you haven't seen that episode at all, basically what a refresh case is, it's when we take a patient under our wing and kind of help them figure out the remainder of their process. ▶Sometimes this is a patient who has been on a long-term temporary, possibly had their implant procedure done overseas. And then we kind of bring them into done-in-one. We declare them a good candidate and then kind of refresh them up and give them a little bit of a break.

So last episode we discussed that what goes into ordering the parts and the pieces and kind of how our doctors clarify candidacy for these patients and what kind of goes into that. Yeah, so I think kind of where we left off, like you said, with the parts and pieces and the number one important part is the, what's called the multi-unit abutment. Yes. The multi-unit abutment is essentially like a cone that sticks over the gum. For those that aren't aware or are educating themselves rather.

And that cone does a couple of things. One, it gives sort of a uniform piece so that we can use our scanning equipment to get the accurate levels and locations of the implant. Secondly, it allows for the interface. So where the parts or... Where the teeth match up to the abutment, where that connection happens, it's better for it to be away from the bone and other things that are susceptible to issues and infection and such. And so that allows us to get it away from the edge of the bone and get it up sort of above where the gum tissue is.

So it serves that purpose. And then lastly, it's angled like a cone. ▶And that cone allows it to, allows all of your implants to be not completely straight or parallel. And even dentists that I work with don't understand that parallel is not great. You want a little bit of a flare to it, et cetera. So we have to be able to accommodate for that little extra angulation. When, and I think I've mentioned this a few times in podcasts, but...

When I first started with doing full arch cases, there really wasn't a truly accepted industry standard.

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And they kind of came in a bunch of different shapes and sizes. And in the last 10 years or so, it's sort of become pretty standardized. And to go back to where we left off, getting it to that sort of standardized version or that layout, that standardized piece, is the translation step into getting it into our world and our information. Why is that important? Well, to run an efficient protocol, one, we kind of need everybody on the same page, and you can't just have parts and pieces from everywhere.

Two, we don't have an account with every single vendor. ▶So it can be tough to track these unique pieces down and have to find them. And thirdly, we want to be able to, like I said, not only support that person in the protocol right away but we want to be able to support them really long term and that's probably a lot of what we'll talk about today is that support long term yeah and also kind of what they're looking for in the restoration as well because i know that that's part of dr lax's thought process that when she goes into these refresh cases with the abutments like you're saying they obviously have to match first of all but i know there's a lot to deal with the restorative side of things and where that access hole is actually going to come up for the patient too yeah it has i mean it's all related you know it goes hand in hand so what goes on underneath you know with the implants and the abutments is directly related to what i create on top you know restoring the actual teeth so um it's it's a very complex type of situation but these refresh cases like you said it gives us a glimpse into kind of what used to be now everything's become more standardized which is amazing but it gives us a little bit of a you know a little bit of a sense of what's going on and what's going on and what's going to happen of intro into all that yeah and we've spent a lot of time talking you know that when i'm training a person on doing these refresh cases like yourself doc um probably the hardest part is teaching the ins and outs of this brand works with this and this can do this but we can't do that yeah understanding that flow chart is mega complex in our own way just to try and navigate it um but once you get a handle on it and you get a couple sources of where we can get this standardized piece that's where things can go just very lickety split so there's always this like beginning part of the figuring out what parts and pieces go where and what kind of implants the the person has um which is now primarily your heavy lifting for sure yeah um and there's some headaches still there's always some headaches um but we i think yeah i think we do a pretty good job like prepping the patient for yeah yeah these seem like things that you wouldn't want your provider to say for instance i'm not sure what part this is let me do some investigating yeah when you get here we may not for sure xyz you never want to hear that i think it's a very unique situation i think the refresh is i don't know if this is something that's common at other dental practices at all no because we like we can show dr dan an x-ray and he's like that's you know 99 of the time you can identify the implant you can identify what abutment is on there whereas like i i've definitely shown other doctors that and they're like i'm not sure like let's get the implant usage let's get the details on it like i'm not sure but you are really good about just like looking at an x-ray and 99 of the time like understanding what that is and kind of what needs to be done so i don't know if that's just using your best judgment best imagination kind of looking into restorative science and restorative things too but i'd like to talk about that because you are very good at kind of determining you know what we have going on just by glancing at it which you know takes a lot of skill it's because of doing it over and over and you just learn the telltale signs of you know the macro structure and you know whatnot but there are a lot of resources out there that can help us identify you know what type of implant we're dealing with just by looking at a panoramic x-ray which is great but i'd like to hear you know your thoughts on how you go about this well interestingly i would say that probably the least reliable form of information when you're trying to identify what type of implant system is being used is probably from the provider the number one right the number one worst source of information

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is whatever crap sheet that they send us it's biased i guess in some way i don't know it's always uh somebody's retired or something and they don't have the unless it's one of the big guys and the big guys then we already know yeah we received one in spanish before i think we talked about in our last episode a whole entire report i had to use a added like that but we did it we did it my um fascination with these cases comes from the fascination of the history of these little tiny screws that you know were were sort of found accidentally that they worked and then turned into this huge mega portion of dentistry itself and so i've always kind of had a um i've always sort of like identified with sort of the puzzle that is putting these pieces together identifying implants so there was a natural fit to start working with these cases and start fixing them um of course though when you when you start to fit these cases there's other things that we have to look at too not just the implant position not just what brand it is but we also have to work pretty hard to figure out will it fit okay because one thing that dr lax has to work with is is this going to break or is this going to chip and a lot of that has to do with the material strength in in the sense of the amount of material that we can use to take up the where the space are so if it wasn't really placed very well then we're going to have an issue so that's something that you know there's some risks that are involved and that is part of the process of trying to figure out uh or communicate to a patient we need this space this might need this you know this this implant may need to come out but we're not sure yet this is all things that we're trying to evaluate and try to mitigate and and find the best most optimal result for them with the least amount of pain obviously but figuring that part out is is a is a lot of work and if we don't do it then we have to there's something that might get compromised and um so just as a blanket statement weirdly enough we're a center that offers this refresh we offer if you have it if you're stuck in a temporary you don't like your practitioner from before you don't like those teeth they're old and they broke and you don't know where to go all of those people we accept and take care of those cases on a regular basis but simultaneously if you come in with one or two implants you're going to have to replace them um generally speaking we're going to replace them i was going to say just for clarification these are implants that were specifically already placed for full arch these are not single unit implants or just ones that were there from a couple years ago someone threw in to hold you over you hit you hit it right on the head that's where i was leading it was the reason for that is if it was not placed for a full arch pretty much let's it's got to go um there's been some that we've wanted to change and the patient didn't let us and then you just almost always it's like that gut intuition you always want to follow it like there's there's one guy specifically i can remember he had something like seven or eight implants i think we probably spent like four thousand dollars on parts because it was the only place we could get them at the time and there just wasn't enough material and it just that just really blew up in our face it's just less predictable it's so less yeah yourself into that's really what it comes down to yeah but that being said what's cool about it is um that once we get this case you and i work uh you and i doc work very hand in hand well really the three of us work very hand in hand in every single one of these cases um but when we we we work uh for a case that doesn't require any surgery we work pretty intimately to make sure that all of those t's are crossed and i's are dotted um but the work doesn't really stop when we're done with just finding the parts and pieces because there's a switch over if there's the wrong parts we have to switch them over we have to have those considerations and those conversations about the prosthetics really it's one of the simplest things that we can do because it's not surgery and it's not managing our normal pain fattening factors and big event type you know infection risk and all of that it's cost effective yeah right it's cost effective but it's one of those that has like the least amount of risk and like yeah but but almost has the most amount of prep work right exactly i would say definitely double double the prep work that goes into a procedure yeah not only from the consultation or you know my end or the patient's end but just on you guys as far as making sure that that person is a good candidate because exactly and i was actually thinking about this the other day um i think it's really important at least when i started doing these types of cases to go into it with a more of like a solutions based or focused mindset as opposed to critiquing whatever provider they just came from because just emotionally right this patient has gone through something they're looking for something better to be fixed and so we're again solutions focused so we don't really dive in too much to what exactly went wrong or why it was done the way it was or you know the problems that they're facing we're going to fix it we're going to make it better i feel like that's just a good way to dive into these types of things i was going to bring it up at the end but since you brought it up i'm going to bring it in now of all the cases that we do a refresh case um gone smoothly and prepared for correctly with the right is probably the most rewarding because generally speaking they're going from something that's old and dilapidated was a bad experience somewhere else they didn't like the way that it looked something was hugely wrong about it and so the win is putting them back together in this nice

Part 414:18

sort of simple protocol box that kind of gets them in a headspace that is wow this really can be the not the nightmare i already experienced or whatever yeah and i would say that when you contrast that to the other patients they may seem on social media like a bigger transformation from two teeth showing to a full set of teeth we always talk about a person that goes from teeth into teeth really isn't as appreciative as they could be because they never really had to learn what it was like to go without or have this heartache or this big issue not that it's anything against them but it's something that they're missing yeah and a lot of refreshes have felt pain and yeah you know disappointment and dejection and embarrassment right the same things that got them in that scenario and so if we can get them prepped into a position where we have the parts and pieces ready to go then the protocol does its job and the wins are very smooth and simple i would say yeah and that's really all it is you know i guess from my end where i you know go from where we left off after we identify the implants make sure that the foundation is solid so we can now build on top we've discovered the abutments we've ordered the appropriate parts that's all done it now just becomes our protocol that we do every day and so it's it's just much more predictable it's it becomes a lot more enjoyable and it just changes everything for them it's a lot like cooking you assemble all of your green ants and if you have the right ones and you did a good job assembling them then assembling it can be enjoyable and fun for everybody involved yeah but if you are missing one thing like baking powder for the one thing like you are in trouble yeah um so it comes down to just preparation yeah you know doing the research ahead of time clearly explaining the details to the patient being on the same page the whole time and just going one by one together yeah the fun is in the variety there isn't one single case that's ever the same no really ever fun about it honestly it just mixes it up it becomes a little bit it becomes you know stressful sometimes exciting most of the time um just because you want to do well for these patients you don't want to be a repeat of whatever they went through before yeah um and so yeah preparation and just being able to enjoy it while you're doing it we um once that person goes through they then are in the system from a we have your file we know where your implants are we can then provide support and we then have converted you into a world that we find manageable if you will and in being able to manage that we then can offer the warranty we would not be able to do that mhm it was a hodgepodge and let's say it was two implants that didn't have a standard multi-unit and two that did well say you do all this work for all these parts and pieces and the two that did have the right parts were the ones that went wrong or failed now you're really kind of in a situation because it doesn't play very well in our system so it can be hard for a patient to wrap their head around like are they up to something are they not up to something do i really get the warranty do i get the warranty it's once we get them converted we can just hit the easy button because now all of your implants are sort of in our world your teeth are in our trust them it's that trust that we instill in it so why wouldn't we warranty them you know and we want these to last forever and there's no reason why they shouldn't if done properly and have taken care of properly yeah so you for sure and and we also have that time point to have a conversation so sometimes we'll say we need to replace this one because it's no good that's a thousand dollars so your total fee will be eighty five hundred or whatever it is so it gives us a chance to kind of have that up front conversation just from generally just from the x-ray and i think it gives them that kind of insight to like dr locks was saying it really is about building trust with the practice that you're going to be working with now especially coming from you know a temporary or long-term whatever it is that they're currently wearing um but for them to get declared candidacy by one of our providers and be confident enough to be able to join the lifetime warranty is so interesting and like you're saying it's it's very difficult for them to wrap their head around because like how are we going to warranty somebody else's implants but it allows us that conversation hey these are our providers they're either you know your implants are good to go or they're suggesting hey your implants are good to go and they're going to be in your best you know position to add another one here just for the restorative process you know if if something like that is needed if there's an additional implant needed they're explained why it is needed and then it's typically kind of in their ballpark if they you know if they want to do it or not they call the shots um so it kind of allows them that opportunity like what decision do i want to make here am i looking for another long-term temporary or am i wanting something am i going to put the extra whatever it is the five hundred dollars for the additional implant and get a lifetime secure you know secure warranty on this and feel good about it yeah and that's why clear communication is so important because it is important to understand like why these things fail and why they're in the position that they're in because yeah it's it could be implant related it could be multi-unit abutment related it could be the material that their restoration is made of because you know even the strongest material if the design is not so strong it's not going to be able to be so ideal it could fracture if something can go wrong right and so understanding all those details and how it's all intertwined and related i feel like it's just an easier pill for them to swallow once they do make the decision that you know maybe we do have to replace a few implants it's for the best yeah and so it's in their best interest exactly and to that point like you mentioned earlier it's not why they're here it's not how they got to us it's more so just us being able to provide that plan for them moving forward yeah and another thing that's great about once they're in the warranty world sure that's a risk to the company because we have to pay for that but the work and the expense for this type of patient especially comes from getting the right parts and building the teeth the once you have the file and you know where teeth need to be and where the existing implants are reassembling that case with an implant additive is a is kind of a nothing it's yeah it's easy it used to be this big significant horrific process and that's i tell people we tell people all the time in the consults like i can sell you on six and that is going to seem like awesome because it's more is better it's not and the reason why we used to do six and the reason why we used to do more implants is we were over building the case so that we didn't have to make those teeth again well with the advent of being able to build a better set of teeth quicker from a digital world and be able to create a temporary set almost immediately that changes the game entirely because not to be flippant about it but if you lose an implant what do i care it's going to take four four to eight minutes to replace and then we take a new scan and incorporate that into the file so you know it's not very much off of dr lax's time it's two interactions for you erica it's one interaction for me and the patient's back off and running so that's been sort of like the most fun thing of doing this is being able to see the transition from sort of being self-serving and creating an insurance policy for ourselves so we didn't have to dr lax and i didn't have to hate each other for because i was making her pay half the bill because my implant failed or something right which is what happened uh now we can kind of more altruistically patient not be get bought not get bogged down in the details cover their warranty you know cover their implants in a warranty it's a it's very very fun it's not like it used to be no i'm sure it was very stressful back in the day um it was it was stressful because you didn't know it you never really felt like what is the real answer right like what is actually best for this person not with my you know bias involved right you you would always convince yourself you weren't yeah but at the end of the day you were yeah you just convinced yourself in a way that you were not bringing in your own bias because it's what's best for the patient too because i don't have to have a conversation with them about how they're going to pay for it right you know because at that point it's kind of their body and their responsibility too yeah it's very free a lot of overhead a lot of work involved so it's very freeing yeah i can think of one patient i think we're going to try to get a patient on from a refresh at some point yes great i can think of

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one patient in particular and i think it might have just been before just before you um it was before we really had a program and it was a lady who had been to one of the big boxes and not their fault directly but she had they had sent it to several different labs and she came in with maybe like three or four zirconias and um i could tell they were all sort of denture copies and so i told here's what i'm going to charge you to do it and she lost her mind at that and then i think it probably took two or three visits two or three sets and she was done and in the final and she was one of the loudest happiest patients i've ever seen really yeah um a lot of it came down she was african-american and she had the um her gums just weren't the right color and um but i remember she had this like really springy curly hair it was like my sister's almost um but she was just running up and down the office like in excitement and that feeling was so awesome yeah um which was i could probably point at that and say that that was sort of the inspiration the good one of the good stories of why we wanted to push this on because yeah as much as this person that needs a refresh has needs an answer they've already been through the pain and the uh the point the pain of the of the teeth failing the disappointment embarrassment of having to come to terms with taking them out the absolute misery of paying for it the misery of having to pick somebody that they trusted say it's somebody that that they didn't uh have a good experience with they've already been through that like three or four different huge hurdles yeah uh and now they're kind of coming back to the table so um but what's cool is that they've already been through they have been through all that and the joy that you get from them for making it smooth and easy is finally done finally through it finally being happy with their results yeah i think that's honestly that's the best part just putting a new perspective on things and you know just kind of getting rid of all their trauma that they've been through in the past so that's for me that's the best part about all this it's it's worth all the investigative work and ordering the things at the end of the day as long as they're leaving happy not hating dentists anymore that's a good day for me it keeps us alive yeah it's something that is dentists are fidgeters and we like small parts and pieces and nuances and there's nothing that's smaller pieces and more nuanced than a refresh case no um but we've had them all at this point we've had you know that lady who had gone through a couple different versions of zirconia and it was an aesthetic issue

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um just right around that same time we had a guy who had been in a hybrid for like 10 years and he was one of the old styles which was a metal bar and a plastic denture um yeah you've seen a few of those um we've had the people that have gone out of the country that were flabbergasted when we said that we would accept them and bring them on i was trying to think of what countries we've seen turkey i don't know if we've ever taken one across the finish line with turkey we've had lots of interest from people from turkey yeah definitely which really sucks because turkey the implants that they use there is the most compatible that i've seen as an out-of-state or out-of-country type we did brazil right i can think of one guy from brazil korea i think or japan maybe um the implant was the implants i don't know where they were treated might have been mexico we've traded we've traded a lot from out of out of the country but the uh where were we going with that well just i was saying like we've had the out-of-countries and that always comes with surprise and excitement from them because they're kind of for a lot of them they're putting a putting to bed sort of a not what they expected experience and getting to experience you know good proper training and good proper protocol technique etc not that it can't be done out out of the country but um there's always maintenance as well i think now there's a big focus on our part on that so it's not just sending them home and calling it a day it's it's like building that relationship you know making sure that these are going to last hopefully and it's all about prevention yeah investing in yourself but responsibly so that we can then have a responsibility to the patient as well yeah exactly we do get a lot of consultations we do get a lot of consultations who are kind of like in between of like going you know staying in country and kind of like going with us or going out of country i've seen a lot i've seen costa rica i've seen brazil i've seen turkey a lot of those places are you know in consideration for for people and i don't know it's just interesting yeah it's always been interesting i always um i i really love the fact that they end up staying with us as opposed to going somewhere else because like i said before it's all about building that trust long term and it is about maintenance at the end of the day and i think that's a big misconception when it comes to full arch um especially with just people i've spoken to that have gone through it elsewhere and sometimes there isn't a big focus on that and so it kind of shifts their mindset a little bit yeah and uh it gives them that peace of mind that whatever it is we got it yeah just like being here being able to you know always come back to us whenever they needed to if they needed for for maintenance you know and i think that's or a little bit of a routine checkup or a little bit of an adjustment whatever it is it's definitely a little bit in my opinion easier to access for sure than going out of the country yeah i think that the data is really poor for recall frequency and interesting the money has always traditionally been in doing the case and so many companies are motivated to not pick up the dirt on the floor as it were right you know they want the big cash up front and then they jack up their rates to not have any responsibility to the patient and um not that i or we are perfect and that's like our only focus but there's a lot to be made in maintaining them and there's a lot to be garnered from a patient's um you know uh allegiance to you by taking care of them and um that's just like financial and the responsibility side yeah there's also a lot of cases when whenever i worked for some place that didn't have any good maintenance program either they wanted to treat them clean them too often and their price was too expensive and it was like do you guys not even care that this is six hundred dollars every four months for these people and you're even hurting their prosthesis um but then there's the flip side where they don't see them enough and i think that unfortunately the i think that the papers that have been written are largely just opinion papers they're not really going off of true good data and anyone that's really practiced hybrid dentistry for any a long job like long amount of time sees like stuff can happen this is still in the human body people still don't take care of it properly you know you kind of have to parent people yeah along the way i feel like personally the the to determine the success of full arch right restoration implants it's not determined on day one it's you're looking at it five years from now and what's going on at that point right so it's longevity so it's all about that's something i've never really thought about and it's probably not even the right thing to bring up now but um to your point success of a case is not how infrequently it breaks or how frequently it does how many implants have failed how what it's on the patient and the and the provider to determine if it's successful or not did it inconvenience your life to the point that you were annoyed did it hurt way too much is it too expensive like what are the breaking factors if all of those are kept in check is you know is an implant case is a hybrid case that's 20 years out and has had two failures and two different sets along the way successful or not a success well you'd have to ask the people that were involved the dentist the the staff involved in the patient if they're happy then why is that not a successful case um yeah something i've never really kind of considered yeah that's why it is hard to look at a case and make a judgment on it we really don't know

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we don't know much what we do know is that they need some teeth some new teeth some nice new teeth yeah do you remember your first refresh or like kind of someone who was interested in swapping over like what was that experience like well we always we call them retreads when i started okay um i can't remember like the specific one the first one um but when we were doing them before digital bars reinforcement bars um or right right when digital bars were coming out um we would be able to do that and we would be able to do that and we would be able to do that and we would be able to take physical impressions which were not as accurate as the digital stuff but we would be able to work around and fix fix them and those happen more frequently than you'd think because it's just a denture essentially glued to a a metal bar so the teeth kind of become unglued or they crack in half and so what it was typically called was a retread and a retread just meant they'd burn all of the plastic off of the bar you'd reuse that bar and then you'd put a new base of wax and denture tooth on it get it so that it was adjusted fine for the patient enough and then you would process it like a denture again so because it sat on that bar you really didn't have to mess with like implant stuff yeah that will in the very beginning yeah things like refreshes were were retreads were um were just building to that bar again that was why it was more popular would you say um you mean to redo a case like that that type of restoration that type of design um why because of simplicity the metal bar yeah um it was more popular because um you mean like besides like a bridge regular bridge um yeah there was a little bit of a float to it you could kind of get a little bit more bang for buck it was kind of uh stuck in between a denture and a bridge obviously yeah um but it was something that you could reliably do for less expense than custom-made bridges with custom abutments um but even then it wasn't it was custom but it wasn't like it seems like a retread would be more of like an aesthetic focus based it was but it was also functional when these things would break they'd break right along the spine of where the where the bar was and so you'd almost invariably maybe a patient would have to do that but it was like a piece of it in their hand and which would be what the precipitating factor would be but sometimes you'd take it out for cleaning and it would just kind of fall apart in your hands because it was like that like half broken plastic kind of thing another thing that would happen when we were doing dealing with materials that were not zirconia based we're talking nanoceramics pmmas anything plastic based retreads anything is that as they were getting cleaned when you cut the the filling material out of the plastic it would just kind of fall apart and it would just kind of out it would get progressively bigger and bigger and bigger and so you would you would also have

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that weakening the prosthesis too so um i think that probably where the whole idea for remaking these kind of cases was seeing that old style not being performing well enough but then also seeing the parts and pieces kind of come to this like confluence of oh we can standardize it and then live inside of our world which we can kind of perform long term for them one on their expectation side but also on our side from uh we know what we're doing with this case um because as much as i enjoy knowing the nuances of the implants and the systems and the different parts and pieces that go to it that's not what my career is my career is not like figuring those out so um and those can suck your whole world up yeah um you just happen to be really good at it well it was just fascination with the parts and the pieces and the history behind it i have no idea where i'll tell you where it came from it becomes an obsession side story because it's so for sure yeah i can tell you specifically i had never considered perio i was on my first rotation in perio there was a guy his name is matthew wait he uh was from lsu he had been displaced from one of the hurricanes i think hurricane katrina and they had to replace all of their residents into the different programs and so he got displaced or moved or rehoused if you will at the perio program and he was the one that i got linked up with for the first time i didn't know what an implant was i was like third year i had no idea like what a dental implant was at that point it just wasn't a huge part of the curriculum he sat there for probably three hours and told me all of the nuances of the different kits and the different screws you know the different implants that he had sitting there that they used and why you use this one and why you don't use this one and do you see this one has a hex and this one has an octagon and that drew my fascination which was one of the things that drew me to perio and i feel like i just it's not necessarily owed to him but i've never lost that sort of the way i try to teach an implant to a person who's like learning is trying to um kind of maybe instill that excitement or something that's always been sort of that historic he was telling me the whole history and i'm like wow that's pretty awesome that's where that came from very cool you should do an episode about the history and progression of how implants have started or started and where they've are now i could teach a long that could be a seven hour episode i agree with dr lindsey true true yeah well i think that's about it for refresh i think so too it's it's always a fun interesting time it's always kind of you know like you said it's like a puzzle and at the end of it it's like a huge reward so exactly we're lucky to be a part of these patient stories you know and uh hopefully give them some beautiful strong new teeth yeah yeah and i think that's a good wrap-up is that if you're stuck and if you're in a temporary and you're wondering why you had this done and you're within a couple of days or whatnot of surgery or you're 10 years out and you're broken you know it's broken and you don't know what to do the answer is we're happy to give you an opinion we're happy to assemble your case no obligation there is an answer uh we feel like uh ours is a good one a good widget for fixing these um may not be perfect for everybody but um there are people out there that can take care of you and put you more in a up-to-date situation and keep you current and keep you safe for a long time yeah and that's really what like consultations are all about it's really just information that's you know given over clarification and that's about it yeah all right we'll take us home all right well thank you everybody for listening in on today's episode um it was a lot of fun and we'll see you next time thank you