Ep. 29: Surgery & Restorative: The Two Clinical Phases of Full-Arch

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. Here joining me is Dr. Blake Hauer. Hello, Blake. Hello, hello. And our lovely Nadia Davis. Hello. Welcome, Nadia. Thanks for having me. Nadia is our Boca office restorative, head restorative assistant extraordinaire. She has been on the podcast before, but served to begin with as my surgical assistant, and then decided that she liked teeth better.

And so today what we're going to talk about is why teeth are better than surgery. Nadia? No, what we want to talk about is sort of the behind the looks, not just from the patient experience and the personal side of things, but more of the what to expect and what Nadia's job. And time with a patient will look like and what the restorative process will look like in one of our offices from a standpoint of just what to expect and what's actually happening and what's going on.

So, you know, I think that probably the easiest place to start is why don't we talk about something that's a little uncomfortable, which would be what does the healing look like, you know, up until Nadia. So from Blake and I. From Blake and I and from the surgery side to Nadia, which is, you know, in our system, we don't do teeth the day of. The reason why we don't do teeth the day of is any time that's added to the surgery day is time that that patient's going to be a little bit uncomfortable.

And also those teeth are going to cover the surgical space that needs its time to bleed and clot. And so rather than risk having to go in for emergency bleeding from underneath those teeth, and actually having to go in for emergency bleeding from underneath those teeth, and adding extra time and pain and trauma to the patient, we've believed that leaving the patient without the teeth the night of is sort of simpler, cleaner, and more straightforward for them.

They're going to be on ibuprofen to reduce the swelling and the pain. They'll also be on some sort of pain med and antibiotics and things to take care of and help support them in their healing. And I'd say that they're, I generally tell patients they're going to be in about a five to seven out of 10. They're going to be in about a five to seven out of 10. You might know more about that though, because you're seeing the others.

You see more, I see more of the telling them about it side and you see more of the experiencing it side. So why don't you give us some insight on what's, what is that going to look like for the patient from like, what do you think that that five to seven out of 10 is, is fair? I think it's fair. Day of like night of following the surgery. It's like 50, 50, some patients come in and they're like, Last night was terrible.

I was bleeding all over the place. Gods, I couldn't keep it in. I messed up all of the hotel. Somewhere, someplace there's a hotel executive that absolutely hates us. Yeah, it's gotta be. And then others have a pretty decent night. It's, it's all dependent on the patient and like how coherent they are after the surgery. Cause a lot of them are pretty out of it. But for the most part, it's. Do you think that there's a trend to a patient, a type of patient that does better or worse?

Or is it variable? Is there a 70-year-old white lady is going to experience more pain trend? No. No. I think it's helpful if they have a person come with them, like a family member or a friend or spouse, what have you. ▶If they have someone there to help take care of them, it makes for an easier first night versus having to be by yourself because you have nobody to depend on to administer the meds and make sure that you're changing out your gauze or not changing out your gauze too frequently.

Makes sense. And what about, give me, I'm actually very curious because we really don't see the other side anymore on our side. When they tell you about what they've... What they've eaten and how they were able to get food. The first night? Yeah. First night, it's they're not eating. Most are not eating. Only the bravest will try that out. Most patients just do like protein shakes or Gatorade, water, applesauce. Something that's very easy to consume and soothing.

Yeah. Everybody has a plan until they get implants in the face. Yeah. And then it's... They go into shock and it's like, oh God, I can't eat anything except for baby food and... Yeah. I think one thing to add is after the surgery, you know, I'd say 99% of the time we're using sutures that are going to resorb, usually around five days. So after the surgery is done, we're not really needing to intervene again. And there's no second, you know, procedure to remove anything.

And you're going to be working with a restorative team. Do you find that any times that, you know, sutures get in the way of things or cause any issues for you? Yeah. Or is it pretty much not an issue once you're done with the surgery, you have enough space to do everything you need? No, we have enough space. There's... It's hardly ever that we have any... I think today is the only day that I maybe had one little suture in the way.

And it was like in the front. But I think a lot of times you guys like tie those around the abutments. Oh, it was Blake. Yeah. Yeah. But today was the only day. It's not a big deal, though. They don't typically get in the way. So what did you do?

Part 25:48

You just cut it and we were all good? No, I just scooched it over. Okay. I just pressed the hybrid on it. Just a scooch. Yeah, just a scooch. But that's the cool part about the office is we're all under the same roof. So if you need me to take a look, I'll do it. Yep, I just call you in there. If I need you, we'll do the same. And I think that really makes the experience really good.

On the day after when you're seeing them for the first set of teeth, I've seen you do a topical just sort of numbing gel. Yeah. Do you... Is that the majority of the time that you do that? Do you do that right away? Do you do that on every case? I'd say, yeah. Most times patients, like, will advise that they take something for pain before they come in. But I like to use topical so that the pressure that they feel from that first set of teeth is not as intense as it would be had I not, you know, been able to place topical.

I just like for them to be comfortable. Most of them come in and they're, like, very nervous. They're like, I am so swollen. You're not going to be able to get teeth in. My, like... There's gauze. There's bleeding still. Blood goobers and all that good stuff. But it's... I walk them all through it and let them know, like, no, I know it's scary. It's crazy looking and feeling, but we'll get the teeth in. And most do fine.

Yeah. I think one thing to add is, you know, we have our patients covered. You know, we're going to have you on pain medications. We like to call them, fancy word, analgesics. You're going to typically be on a steroid, which is going to really help with some of that. Post-surgical swelling. You're going to have an antibiotic. We even prescribe for a couple days, if needed, a narcotic for pain control. So, you know, we want our patients to be, you know, controlled well.

Is there anything else I'm missing with the ability of patients? Not terribly. You know, and I just realized as I'm asking these questions, like, it may come across that I am genuinely don't know anything about the other side. And it's not that I don't know. But when, you know, the several thousand restorations... I've done... We're all done sort of my way and my habits and my... The way that, you know, more or less Dean and I did them.

Yeah. And so I'm curious to find out how it's matured and how it's different or not different with you. It's really what I'm, you know, bringing the statement to. Yeah. So when that patient comes in, this is actually interesting thought I just had. So for Blake and I, the patient bringing the escort in the room... It's tough because it almost always makes the behavior of the patient worse. Yeah. ▶It almost always is not a good thing to have a patient escort in surgery.

There are several exceptions here and there, but it's one a year, one every two years. Invariably, it's worse. Oh, no. I have the hiccups, I think. You okay? Yeah. I'm fine. One of my... One of my, like, deep, dark fears is of getting terminal hiccups. Have you ever seen those people that get terminal hiccups? God, I remember you mentioning that a long time ago. That's real? It's just a real fear. Just drink your water upside down. Terminal isn't like...

Have some more water. You're going to die? Well, like, you will hiccup until you die, yeah. Like, for the rest of your life. You sound like me now. How do you sleep? I sleep fine. Do you hiccup at all? I don't. Okay. But I do hiccup, like, once a week. Okay. So now that we have that out of the way...

Part 39:20

Back to the patients and having their... What about for delivering of patients for the teeth? Because I can imagine a side of it that actually makes it positive. And I do notice that there is a decent amount of the patients' escorts or wives and husbands coming in for definitely later on in the process. But what about the day after? Yeah. So day of surgery, they would be in the way because the patient needs to know that they can trust you and the surgical assistant.

So day one, we don't want them back there because we want them to be relaxed. And not to be thinking, like, oh, I'm hurting. Help me. Like, you're there to help them. Day two, with me, I love for them to come back. I love for them to be... I love the group setting. Like, I love for it to be, like, a team effort with... To an extent, right? Because I want for them to have their support system there.

But I don't love when the support system comes in and tries to, like, take over design. Yeah. Hold on. We're kind of limited. Let me do what I do. Let me, you know, design the teeth to fit the patient. And, you know, I am always receptive to, like, feedback so long as they don't go off the deep end. Yeah. And that happens. It's going to happen no matter what, no matter how much education you give them or don't.

And I don't blame them because it's fun. ▶We make it look fun. Like, they come back and they're like, oh, wait, you can change this. You can do that. Well, let's try this. And let's give me... You know, Tom Cruise teeth or what have you. And I love when ideas like that come up. But, you know, so long as they're understanding that we have our limits, too, you know. Limits and also there's a time and place for different particular things.

So you're in many ways sort of like a tour guide, you know, like you're working a ride at Disney, although not as fun as the Disney rides. You are working the ride. And so there are certain places that you... You can look over to the right and see the giraffes and look over to the left and see the hippos. You know, there's a time and a place. So you are the tour guide. And I can see because I'm sure that there's some people that want to jump into the end steps, the grand finale.

Yeah. Because they want to... I mean, everybody wants to make sure that they leave satisfied, leave happy, leave with a set of teeth that make them feel like themselves and if not better than themselves, you know. Do you find that it is tougher to get a good result in the end through all of the different try-ins and prototypes? Do you find that it's more difficult to work on a patient who is... And I'm not talking about the extremes of excessively obsessive about the results and very pushy.

Those are extreme outliers and they exist. But in terms of the bulk of your patients, is it better for them to be on the picky? The picky side or the not picky side? If you could pick your last patient tomorrow to be one particular way, which direction would you... It's an obvious answer. Well, somewhere in the middle. Not too lenient, but not too picky. I like for patients to get what they want out of, you know, what they've invested in.

I want them to feel heard and, you know, like listened to. I like for them to leave feeling like somebody cared enough.

Part 412:50

To try. So I'll always try. I just, you know, I'm not good. Well, yeah, sometimes it can be hard to get information out of a person that doesn't necessarily care. That wants to be accommodating to the point that they're unhelpful. Yeah. And I'm sure that it can be the opposite. The same can be true for the opposite. Yeah. I like for people to know, have an idea at least of what direction they want to go. Because it kind of helps me.

To navigate which way I'm going to go. But even when they're not picky, even when they have no idea or they just come and say, I don't care. I just want to get this over with. I just needed to get this done. I still like to know, you know, what was close to home. What is something that they started out with so I can get it like ballpark to what they had. So they, although they don't care today, maybe three months down the road or a year down the road, they're like, hey, thanks.

Thanks for making these. Like, this is me. So many people, like I get so many compliments and I just feel like myself again. Something I want to add is, you know, when we're in the surgery, what we do is we take a tooth template and we use it as a mold to give it the first design prototype of the teeth. And we try to line up many parameters. Now, that first template is a working template. Maybe describe from that point.

What do you look for? What are your goals and sort of like what are what goes in the process? Because there's so many rotations and, you know, dimensions you look at and maybe talk about those aspects because that could be, you know, a whole long lecture of things. Yeah. To keep it simple, I just tried to align the teeth to the patient's anatomy. So I take into consideration, you know, their height, their facial features, their before teeth.

If they've if we have pictures of their natural teeth and try to. Gauge it like ballpark, bring it back to like what they started out with. With the exception of like building them up and whatnot. So it always be a little different from what they started out with. But that template, like I just build off of it. So it's more so once we get the teeth aligned to the patient's anatomy, natural anatomy and their facial features like teeth size and whatnot, then we kind of play a little with the shapes of the teeth, not getting too crazy because.

Sometimes. Less is more. Yeah. And there's so many things that, you know, we want to, you know, make sure the surgery goes well for you. And I feel like another aspect is, you know, lip support, speech. So there's everything that goes into the teeth position really helps other facial features as well. And, you know, function. Yeah. Anatomy guides the majority of. Yes. The big movements. Yep. Which then dictates a lot of the phonetics. Yeah. So I always start off.

▶With following their natural anatomy, aligning the teeth to where their ridges and whatnot. And then from there, that's when the patients will let me know, OK, well, my lips look a little too flat or when I smile, it looks you see too many teeth. It looks too narrow or my tongue doesn't have space. And then that that typically will dictate if I, you know, what what adjustments I make from there. If I come in and my teeth are, you know, say the midline.

The midline is off first set. And I'm immediately talking about the lip support. Do you typically just validate that comment and note it in the back of your head or are you going to try to address it? I try to address it, address, address as much as possible. Day one. I am a big fan of being as aggressive as possible with that first design to get them as comfortable as possible. Day two. Because I could imagine. Having to go home and like a crooked set of teeth, how uncomfortable it would be trying to eat, trying to speak and whatnot.

And I don't want that for them. So I do clock it and then I, you know, adjust from there. And something that I'm constantly sort of hammering in with Dr. Power as we're doing training and such is is something that I try to do is I try to not just get it. I don't try to get it as close as possible necessarily. On the day of surgery. Yeah. And the reason why, um, is I want you to be able to see an extreme.

So as an example, the amount of tooth that is showing from the top lip, you know, I may hide that more on the extreme side. So then that gives you a direction to go or, uh, another example would be the width of the tooth. Sometimes I'll give you the smallest version of tooth that I could possibly think of for that patient or the biggest. Mm-hmm. That you know that you have to go in a direction. Because sometimes when you hit it right on the money, it may.

It's hard. It makes things more difficult. Yes. Um, I can appreciate that because I'm, I'm kind of the same way. Like if I'm ever iffy about the size of the teeth for a patient, I'll go extreme. I'll let them know like, okay, I'm gonna go two sizes bigger because we know this is too small. Um, and maybe two sizes might be perfect or it might be a little too big. We can meet somewhere in the middle. If it's like not, it's too much or not quite enough.

So I can appreciate that because it also lets the patient know, okay, well, I really don't like this. Like these teeth are horse teeth. I don't want this. Yeah. They'll give you the feedback right away. Immediately. Like, no. And it's funny because sometimes some cases will come back and they'll be so big and pushed out and we'll kind of laugh about it. Day one, like me and the patient. And they're like, oh, I don't want this. And then we start the design process.

And sometimes they'll go. They'll go back to day one and say, you know what? Actually, I liked how big those were. And I'm like, we'll meet somewhere in the middle. Yeah. It's, it can be tough hitting Goldilocks straight away. Yeah. You know, you laid on in bed and it's too perfect. Yeah. You go down an extreme of, of going firm or two or softer. You're not sure because the, the one is too perfect. You may end up on the totally wrong end of the spectrum was this sort of.

And that's not for every parameter and it's not for every case. Sometimes we really try to hit it out of the park on, on the first try, but there's sometimes maybe the patient looks like they should be able to, to take a bigger tooth, you know, or, or, uh, their smile would fit for a bigger tooth, but you try in the, the version of teeth that we have. And right away you go, oh, no, no, no, no.

That needs to be way smaller. I'll try to pick an extreme to stay on so that you then again, know a direction. That you want to go from there. Yeah. ▶I don't, I don't always, I won't say that I hate because I love all teeth designs. Like absolutely love this process, but my least favorite, if I had to choose, um, from the day one templates are the ones that come out almost perfect day one. Yeah. Those cases are the hardest way, way more difficult.

Cause it's, it's almost like the patient and I will sit there. We're just kind of stunned. Like, huh, this is, this is kind of good to pick. Yeah. So. I'm going to stop doing worse. Doing great templates. Yeah. No, it's, um, it is funny cause there's, there's a huge variety of the trajectory of that patient. And all these, these little nuances change that person's experience and how everything goes for their, their cases. And once you live in this world for long enough, you have to sit back and wonder like, how in the world is this going to work?

How in the heck did we ever deliver dentures, immediate dentures that were the same, same day or next day or, and even think that that would work? Or how did we ever even think that a 24 hour final nano ceramic was going to work? Because there's so many nuances that are patient dependent. And that is crazy to think about. It is like, we really used to give people final teeth the day after. I can't imagine that now.

Like that would really suck. It's very. It's stressful, but it's stressful. Get them a final sooner, but still. I think something you have to realize, like as a listener, whether you're learning about full arch or you're a prospective patient is that when you go somewhere and you have either a final or a prototype the next day as in one, you're very locked into a design. And sometimes, like we said in the last episode, the digital and analog world, I mean, digital computer design versus analog.

You know, what you may be seeing in the mouth can have a discrepancy when you have this experience in the office and you get to have multiple try-ins and prototypes, as we call it, it's almost like a concierge experience. You know, you're going to really give our team the details that you're looking for and you're going to be heard versus just being locked into this one design because, you know, we can't always rely on what's on the computer to be perfect.

And it takes a lot of conversations. So giving you that, you know, open access to us through Nadia and our restorative doctors is pretty important. I think the way, I'm sorry, I'm still thinking about the giving the finals the next day. There was a workup process beforehand, right? Like they would pick teeth shape and size and all that stuff and then get a final. Okay. They would pick the style, the flavor, as it were. Yeah. And we would do, we would rely more on measurements of the face.

We did a lot of like visual scanning, scanning of the face and such. So there's measurements that you can take that are biologically based for measurements. ▶The problem was that the style of teeth that I may choose today, when there's a book of teeth in front of me, just even speaking for myself, if I was going to have this done tomorrow. If I was going to have this done tomorrow, is wildly different than what may actually look good in me.

Yeah. And that's the difficult part is even as a professional, I don't know what to recommend to someone. Because you almost have to experience it. That's what we tell every patient is that the reason why we've floated away from selecting the tooth right away isn't because we don't have the capability of choosing it. It's because we don't want to lock you into something that's going to make you look like a goofball. Yeah. Or not like you. And.

And just because you chose it, you can choose it. I can choose it. Well, whoever chooses it, that may be the wrong path. And the instant that they turn into the world leading expert on what's appropriate for them, in my opinion, is when that first prototype goes in. Yeah. That's when you start to go, oh, I want that to be more round or I want that to be bigger. I want this to be X, Y, Z. Do you think when you work with the patients for the visits for the prototype, is it enjoyable?

Are they having a good experience? Kind of choosing the design to customization after surgery? Yeah, it is. Most times patients, they they seem to enjoy it, with the exception of having some discomfort following the surgery. Some patients enjoy it a little too much to where they they want to, like, almost play dress up with teeth. And it's like, hold on, this this isn't that. But for the most part, I try and make it a priority. That my patients enjoy their time with the with the restorative department, the restorative team.

Most of them end up leaving feeling like family and they come back and they want to pop up randomly. So I try to make it a make it a different experience for them. I don't like for patients to walk in and feel like, oh, God, like she's not going to listen to me or, you know, I'm not going to be able to voice my opinion and whatnot. Like I like for patients to feel heard. But also be respectful to the, you know, to the to the field, like we have our our limitations for certain things.

What the time that a person is in for a try in from how much work is actually how much in in the mouth are you versus discussing, let's say, on the first try in? How much in the mouth? Like. Like, does it take a long time? Yeah. How long does it take until the teeth are there? Comfortable scan until you're not in their mouth any longer?

Part 525:56

I try to be as quick and efficient as possible and try not to drag that part of the appointment. So. I mean, maybe 20 minutes, 30 minutes, 20 minutes. No, maybe like maybe maybe 10. Oh, yeah. It's fairly quick. Yeah. It's I try not to keep them. They've already been open the day before. You know, in the surgery. So I try not to prolong that. I try to make it quick to where we're removing the cover abutments, seating the teeth, scanning them and then taking photos.

Is that, say, 10 to 15 minutes? Is that consistent through the rest of their time? Is that about how long it is to go through that part of the procedure for each day? Subsequent day as well? I would say, yeah. Yeah. ▶I mean, day two, it's a little easier because you're just changing out. You're changing out the teeth and then scanning and then taking photos. So maybe it's not quite as long. And it's also dependent on the patient's comfort.

If if they're if they're really sore or if they're in like a lot of pain, I haven't I haven't had any patients come in. They're like, I'm in excruciating pain. You can't do this. Like everyone can tolerate it. It's just if they're a little if they're a little more sensitive on their tissue, then I'll take my time. I don't really it's hard for me to say. I don't really I don't time myself. I don't make it. I just focus on they're comfortable.

We put the teeth in, we scan them and then we talk about it. And how long does the rest of the appointment generally take? I mean, I know that they're scheduled out for an hour. How often are you getting to that hour through all of the discussions and getting to know them? The personal aspect as well. Like, is it round trip generally an hour? It's like 45 minutes, an hour. Yeah, that's about what I would expect. But it's as far as like the clinical side of it and like work, the majority of that appointment.

Don't get me in trouble is talking. No, no, no. That's what we hope for. Talking with the patient. That's 100 percent the reason why we designed it the way we did. That's what I always tell people. I brag, if you will. But I always tell people that the most positive part about this is what used to be the dentist or restorative assistance job was to work as hard as you could for the whole time that you were there.

You were grinding and polishing and rinsing off and trying it again. And. Re-screwing in and re-gluing. And that took away from the experience from the patient. But it also took away from you getting to know the patient at all. Yeah. I want us to know the patient to the level that they want to know us. Like, I want that to be the case. If it could be three minutes of actual work and 50 minutes of talking, that would be even better.

Because that helps the patient's experience. It helps you understand what they're looking for. It helps you hear their teeth more. Yep. A hundred percent. Yeah. Yeah. Does I would imagine, though, that day one, because they're already uncomfortable, they've been through a lot already. I would imagine day one is almost the shortest of all the prototype visits, even though they're getting better and more accurate as you go through. Is that maybe a fair thing? Because I would imagine they're getting more comfortable.

They're getting more excitable. They're having more feedback. I'd agree. Yeah. So they do. They do lengthen in time. Yeah, they do. As you get to know them. And, um, when, when the, when it comes to the, by the time you get to the zirconia, let's say that I had surgery last week, if I'm coming in for the zirconia, is that sort of, I'm always tell people, I want to make sure that I'm telling people everything on the console.

It's like the pattern of sort of wearing an old shoe where the first day it's a little uncomfortable, but by the last set that it will be like wearing an old shoe where it becomes comfortable. So my question is when you get to the zirconia, are you still putting on topical? Is there still any need for that? Or like what's their discomfort level on the delivery appointment day? Lately it's been, some patients will tell me not to, not to use it again.

It's, it's, is it pretty minimal by that time or is still like moderate to it's moderate. I would say. Yeah. You tell me, no, I don't think it's necessary or no, I think I'm okay. You know, the installation is pretty straightforward. Very similar to, to seating the PTIs. The only difference is we torque them in and close them up. And most, most times they feel better because it's zirconia. So it feels a little cooler going in versus a, a sticky print, not sticky.

Yeah. Well, comparatively it's sticky. A rough, you know, print or what? Comparatively. I'm always shocked at how, what the feedback is on a zirconia. Yeah. It's crazy. A lot of them are like, it feels smaller and it feels lighter. That lighter is the one that gets me. It's like, how does this feel lighter? It's significantly heavier than the print, but they say it feels lighter. It's always a decision that you have to make when you're talking about doing, you know, in-person consultations, because do you leave the zirconias out and have them, pick it up and go, Oh my goodness, the internet was right.

These things are heavy because we know in practice, they will never, ever feel that difference ever. Have you ever had anyone, I've had one person say that they were, they felt heavy and they were annoying because they were heavier in all of my thousands and thousands of arches. Have you ever had any? I probably only had like one, one say that. Same. It was a guy, I think. Yeah. I think I know who you're talking about. But, um,

Part 631:47

um, wonderful. So the, when they get to the final, so what I wanted to know was once you've lined up their anatomy and you're just following an anatomical basics, how much of that work is dialing in the phonetics, like the speech patterns? Do you find that it's, it just comes along with the process or do you find that there's a period and everybody's. Hybrid journey or a bulk of hybrid journeys that are okay. Now we have the basics here.

Now I have to adjust it so you can speak properly. We, we try and gauge it with every try in because any little change can lead to, you know, a change in speech and whatnot. So we try to gauge it at every appointment and try to stay conscious of it, you know? Um, so like every appointment. Yeah. So you're making minor tweaks all along the way, regardless of necessarily where your end goal is going to be or what change you're going to make.

You're just going to kind of keep that in mind. Yep. And then if it comes to like the patient speech is a little off, but they want more lip support or they want the teeth to be bigger or they want them to be more narrow than. So I feel like I like, um, I like being transparent with my patients. So I just let them know, okay, if we go a little bit smaller, then this is what's, what's going to come of it a little bit bigger than this and so on and so forth.

She's a composer of an orchestra. She is. She's, and she's dang good at it too. Every moving part has an effect. Yeah, absolutely. What, um, if you were given the choice of seeing a column, same amount of work, but it's a column of follow-up cleaning patients or try-ins. I know you see a variety every day. I'm asking you if you had to commit. So one day, tomorrow's your last day. You're going to commit to one. Would you rather see the follow-up cleaning patients to see how they're doing and catch up with them?

Or would you rather start the new stuff? That's a hard question. ▶I love my patients and I love seeing them years after years coming back and just hearing about them, like doing life with their teeth. But I also love the puzzles of like building the teeth. So I'm not answering that. I would have probably guessed. New patients would have won because of your passion for like, I was telling him on the way over here that you are, you might even beat me in your desire to learn about anything along life.

Um, but specifically we'll say teeth, but like I wake up and that's what I live to like learn something new or like find something out or, you know, like documentaries are my jam. That's my favorite kind of TV. And. I, so I would, I would have guessed that you, the puzzle side of it and learning that side would have been what you leaned towards, but I'm, I put you on the spot. It's not very fair. Um, awesome.

Do you have anything else, doc? Um, what, what, if you had any, I'll let you think. I had no chance to say, well, you said, um, so I was, I was, I'm being into a thought, but I go, go for it. I was going to ask Nadia to give us, um, top. Top things that Dr. Hauer and Dr. Noorthoek need to change on a day-to-day basis. All right. Where do I begin? Here we go. Let's just preface by saying that we've been doing some cases together for a couple months.

So limited sample size. No, but is there a trend that you like what we need to address or change? No. Just in terms of like your, your center line, your midline is always consistently left. Or this, like, is there a, is there something that you see if somebody else was doing the case, could you tell that it wasn't me just based on the way that the first case came in? I want to say, yeah, because the bites have been like, usually yours are like slightly misaligned.

They've been kind of like in a cross bite. So I don't know if it's like, I don't know. I don't want to, I don't want to answer that. You guys are doing great. Like it's going great. You're doing great. She pretty much told us don't give me a good situation. Yeah. Yeah. So anything is good now, right? Yes. Well, the, and that's the cool part is that if you, when you were under the gun, making that decision on surgery, that patient did not want to be there.

So the, the difference is the patient didn't want to be there anymore. Fully sedated. They've been there all day and you had to get the last bit of X, Y, Z information, uh, line it up with the computers, whatever it may be, any little nuance. The theme was that the patient didn't want to be there. Even if you got that data and the risk was that you would have something like the bite being way off and cross bite or something.

And that, that stress and that pressure and that tension was not positive. And what's cool about it is regardless of how good or off or on my data to you is from there, cleaning, it becomes exponential and very train tracks. Very repeatable and very patternistic.

Part 737:17

Yep. And that's, what's very rewarding is because when you get that first set in every time you, you already know, not, he doesn't go home on Friday. Like, well, you probably do think about the case, but you don't go home and say, man, I hope that zirconia goes well. I don't think they're going to like those at all. No. By the time we get ready to go to zirconia, we know where like on the money. Yeah. And that's really fun.

I don't lose. ▶I don't sleep over my zirconia. I would go toe to toe with anybody in the country in terms of their sleep had the night before a zirconia goes. Yeah. We, by and far, have the most sleep. Same. The smallest worries. Talk to you tomorrow. Anything else you have to add, doc? You gave me a lot of time to ponder about what I did. Honestly, I've been listening and not really pondering, but no, I think we covered a lot.

I think just to reinforce what I truly meant before is that you're getting a concierge service and you're getting a really good time with our restorative team, which is unique to other places. And there's a lot of details that go into it, whether it's functional on your bite, aesthetics, phonetics, facial features, lip support. So all these things go into the process. And it's all part of the console. You know, we want to be clear that we're surgically driven, but also prosthetically driven.

And we want to give you a really nice result. And on that note, my closing thing for Nadia will be. I want the top thing, if there is one, that you have seen consistently help with the patient's experience the night the night of surgery. That not everyone has. Is there any top tip that you have for someone like, oh, I use X, Y, Z, or I had X, Y, Z. I know we said X, S court. That was a big one.

Um, that helps them to, to, to have a good first night. Yeah. Do you. Okay. I'll switch this question on you. Do you think that the head wrap ice packs work? I think, I think. Yeah. I think if it, if it makes for less work for the patient to have to do, then yeah. Then maybe they'll use it more. Yeah. Maybe like a head wrap, but that will keep the ice on their cheeks. Most head wraps will keep like the ice, like maybe down here.

They're awkward. I'll make you something. I'll build you something. I had a, we had when we back in 2020, we had a phone call, like an initial sales guy who. Got on this track of recommending this one particular head wrap and in my opinion, it didn't help at all and he would, no matter how often I told him to stop telling patients to buy it, they would all come into the console and saying, I'm going to buy this and I already bought this and I'm ready or whatnot.

And that was maddening because it's like, no matter what I said, I couldn't get rid of it. Yeah. Um, what about top tips? Nadia's top tips for. What to bring into surgery or what to prepare for once you're in a set of teeth? Like, is there anything that a person can do that would better help you and not get in the way of, of you helping make decisions? So that teeth selection, or is it better in your opinion to go in with an open mind?

I, yeah, that patients come in with an open mind and it's just coming in with an open mind. Cause I feel like. Both photos help because it lets me know what direction to go. Um, but so long as they're trusting of the process and come in with an open mind and know that they're in good hands, um, that makes for the best time for any patient. That's good. I won't drag that. Nadia's top tip for preparation of teeth.

Just trust me. Keep an open mind. And, you know, there's a, there's a version of Nadia. And that's what's sort of really cool is to see how each, each office has its own person that kind of develops as being that sort of lead person. And that takes charge of, and, and helps kind of control the, the narrative of, of the surgeries. So, well, we appreciate your time, Nadia. I say, we, I appreciate your time, Dr. Howard. I agree.

Volunteering. Yeah. Thanks for having me. Now we're off to happy hour. Happy hour with the team. Maybe some noodles. What do they have there? Some sushi, maybe? Sushi. All right.

Part 842:19

You already had a sub today though. You're probably pretty full. I'm full. Yeah. You're done. We have a list. If anyone comes down before or after surgery, we have definitely have some lists of some good places to go. Did you like today? I liked today. Had you ever had VNS before? No. That was my first time. Shout out VNS subs. VNS. Italian classic sub. It's great. VNS is a deli that started in Boca in like 1983 or 87, somewhere in there.

And it's a Boca staple, no doubt. It's good. Absolutely. ▶Well, we thank you for your time and like, subscribe, cheer Nadia on as you come and get your teeth done. And we hope to see you soon. And we'll see you next time on Beyond the Arches. Go Nadia. Thanks, everybody.