Ep. 25: The Myth of the 24-Hour Finals

Part 10:00

This is Beyond the Arches, where full-arch dentistry meets real talk. Let's get into it. Hello and welcome to another episode of Beyond the Arches. I'm your host, Dr. Daniel Noorthoek. Today we are blessed with Lilia. Hello. Welcome, Lilia. Welcome back. Thank you. It's been a little while. It has been a little while. We were just talking about that. How have you been? All is good. We're busy getting Jacksonville put together, right? Yeah. Heading there tomorrow. Yeah. Early day.

We've had some nice consults and things set up, so things are tracking along nicely. Yeah, definitely. Slow and smooth growth. Yep. So today what we're going to talk about is the fallacy of the 24-hour final. And we're going to be covering sort of the shortcomings and issues that we used to experience. And maybe you'll get into a little bit of the shortcomings of making artistic decisions

▶that... You know, things like that. And so as I was thinking about talking about this coming into work this morning, I was thinking about how we've all... You know, let's say that you probably have a way that you like your chicken or your burger or something, right? You go to a restaurant, you order it exactly the way that you want. You see the one that's like kind of like it, but you know, you don't like ketchup, so you ask for it to not have ketchup, et cetera.

Et cetera, right? Medium, rare, whatever. And it comes out and it's just not perfect, right? Well, it's still a burger, still been assembled. Who's to say that it was wrong besides yourself? Yeah. Right? You're kind of the only one and your taste buds and your preferences, they're going to be able to say that that's wrong. And that is a little bit of like the best example that I can think of for why 24-hour finals can be a little bit of an issue.

It's not that they're ever... Done wrong. It's not that doing it that way is wrong. It's that getting that perfect flavor for Lilia can be an issue. Yeah. We all have our preferences. We all have our preferences and it's really hard to get out without being able to see and feel and experiencing it. I think a lot of people sometimes don't know what their preferences are until they're in the midst of it. That's another thing as well, right?

So the selection of teeth. Mm-hmm. And... And we do a lot of... A lot of times when we're in the consults, we say, listen, I'm not going to shove a book full of teeth in front of you because I don't want you to pick anything out. Yeah. Because I can't tell myself what is going to be your perfect shape and size. Yeah. And I don't, you know, know you from outside of another, you know, an hour consult or whatnot.

▶And we find generally that when those teeth, that first set of teeth go in, they're the biggest critics of where things should go. Definitely. Now, let's talk a little bit first about what allows for a 24-hour final. So when you do it the old way, it was a lot of physical manipulation. We take the impression, we bring that to a lab, make a regular denture, generally off of teeth that we selected with a patient in the consult.

This is back in the day. Yeah. And order those teeth and have a... Mm-hmm. Regular denture made and then kind of re-glue it together. Mm-hmm. When you do that, you're kind of locked into that being the decision and anything that happens in the surgery is sort of stuck. And so the fight, and I've mentioned it before, but I think we were, when we were starting, when I was starting in Jacksonville to do these 24-hour finals, we might have been the second center in the world.

Mm-hmm. To do it somewhere around there, third. And it was exciting. We thought, listen, putting all of this tech together, getting teeth in right away, that's going to be what patients want. Yeah. And we found that that was, over time, you know, it probably took a good four years for me to really learn the lesson because it worked really well. And what we used to do is we would combine the technology that allowed us to do it was a lot of like face scan.

Right? We'd take a scan of the person's face so that the person on the computer designing the teeth could see where the nose was and the eyes and the ears and the heights and the different amount of lip support and things. And then you would combine that with the scans and you would build it to be a cohesive model of something, not something of their jaw. And that file then was made. It was made and produced and done into a final.

And so let's talk real quick. We've kind of talked about with Dr. Laks before, there's different landmarks that give us guidance. You know, if I'm looking at a patient and, you know, the eyes are supposed to be equal with, parallel with the patient's set of teeth, their occlusion, their bite. And you can see that on a great scan, right? Right. That's a very, that was an expensive piece of equipment. It was something that had to go in every office that offered something quick to final.

It was a way for our designers to have the confidence that they could make it. But you get all of those parts and pieces together and you line up everyone's schedule to make a final. And maybe the data was just a little bit different or the patient's preference was a little bit different. It can lead to a really disappointing scenario. Yeah. I mean, I can see. I can see as the dentist being, you know, disappointed that they're not as happy as you thought.

And I can also see as a patient, like thinking you have this whole idea of what you're going

Part 26:09

to get and it's, you know, not quite what you wanted and it's probably let down for both. Definitely. I can see the frustrations on both ends. It's a lot of decision making right up front. Yeah. Can you imagine in the consult, because that would be about when we would do it, taking the imaging, that's fine. You know, probably you would be involved in the image taking. But can you imagine sitting down and having them pick the set of the color of teeth and the size right away stuff?

Yeah. I'm so I'm such an indecisive person on like my personal decisions like that, that I don't even know how that would feel. And I can already see our patients who they have the, the, a week over a week and they can still have, you know, be a little indecisive, which is totally normal, but I can't imagine being like, this is the moment to pick out everything, the color X, Y, Z. Yeah. It's. It's a lot of pressure and it to, to, to give an example of the pressure or even just, it's actually not even necessarily pressure.

It's just, we have all had a scenario. I don't do a lot of shopping, but I, I ski a lot. There was a year where I saw a particular ski jacket and I loved it. I absolutely thought it was the coolest looking thing and I loved where all the zippers were and just, I, I. You know, idolized or looked at it a lot. And I finally, I decided to get it or, or wanted to get it. And I walked into the store and one of those little ski, you know, towns walk in and try it on.

It looks terrible on me, you know, it just looks like, what are you trying to be 15 again? You know, just dumb. And I would have sworn to you that that's going to be the jacket I wear the rest of my life. And the point being is that was just a jacket and that was, uh, something that we've all, we all have worn clothes before. So I already know what colors and things I like. And I'm sure you're thinking of, you can think of many examples of a dress you see on the rack and you say, Oh, that'd be awesome.

I can't wait for that one. It's the most upset. It's so frustrating. Like you said, it's just clothes, but this is your teeth, you know, it's supposed to be permanent for you. And the expense that goes into it too. So the, and even if it looks good on you, maybe it was the wrong one. It's the wrong size because that particular brand runs different. ▶And so you ran into a lot of those issues with going to a permanent final set of teeth right away, just on the selection and the patient satisfaction alone from the looks.

And I try to delineate for people too. It's not that a final doesn't work and it's not that you can't get a good bite. You know, the bike could be perfect. The color of the jacket could have been perfect. Yeah. But something could have been wrong just enough in preference wise. Maybe it's like hugs you up, you know, hugs you a little bit much, or you don't like the material and that right away, you're already on the road of, of disappointment and frustration and sort of conflict that, that wasn't a great feeling.

And the other part that goes into it too, as you know, this is a big psychological movement for these patients. And it's a journey that you in, in a 24 hour final, you only get a very small snippet of the journey and all of that emotion and all of that selection is packed into really a couple of visits. And we used to see that patients would say, that's it.

Part 39:47

I've spent $35,000 on this or 40,000 or whatever the number was. What do you even say? And you go, yeah, that's, that's it. And I say, well, you didn't even do anything. It was like two hours. What did I, what did I pay for? Of course there was a lot of work and scheduling. It was more expensive than it is now because there was a lot of lining up very highly specialized and highly trained people to get everything lined up, uh, to make the final overnight and such.

We had a big, big lab staff at the time. I can only imagine. What about like in the consult where patients, cause I'm thinking about now, were they ever like, I don't get to try it in? Like did anybody question that? No. I think they were just. I think they were mostly excited about having a very limited window of time that they're committed to it. Yeah. And it wasn't until we saw a lot of those frustrations that we started saying, okay, is there a better way to give them value and get the customization, but still accomplish all the goals?

▶Because the goal, whether it be a 24 hour final or like ours, which is generally a seven day process, the goal is to get the best, highest quality of teeth. Yeah. That you can in the mouth. And again, 24 hour final, you can get a good bite. You can get it down the center line. You can get good results. Yeah. And quickly, obviously, uh, the difference is that it's how the patient feels. Yeah. And the patient is the most important, obviously.

Yeah. I feel like that would just start to break you after a while. If it was just patient after patient kind of being, and like you said, not that there wasn't many patients that were happy, but even the few patients. I mean, that would be a good thing. And so it's a good thing. So I think it's a good thing. You would never got to see a 24 hour final, correct? No. More than anything. Surprisingly, what we would get is the bite would be a little bit off.

It's very hard to get that perfect bite captured right at surgery. Yeah. They've been open and all of that. So you get whatever bite is there. And more often than not, even if it was just minimal adjustment, if it was just a little bit off, you would get a little bit of a bite. A patient would be very upset if we were adjusting anything. Oh, really? And sometimes it was more than it should have been. Thinking like it's supposed to be exactly perfect.

Okay. And that makes sense, but definitely from knowing on the other end of the dental team, I know that it can be adjusted. It may need to be adjusted, but I can see them thinking like, ▶I don't have to, I love everything. I don't have to change anything. It's going to be perfect. And then. It's tough. It's, um, I would say that that was more, more often than I didn't get to select my teeth, which was maybe 20% of the complaints that you would get, you know, under their breath, or you would, you would hear probably 50% of the complaints were, you just ground down what you said was a final.

That was very frustrating. Yeah. Because it was hard to capture. It was hard to explain. Well, that's no big deal because it is kind of a big deal. Yeah. And, and. And that's, I don't want to also instill an, an attitude towards the bite should be perfect because there are adjustments that are needed, but when you're adjusting a zirconia at the stage of when it's finished, it's, it can be a little bit damaging, more damaging than you want it to be.

It has to be the right amount of irrigation. It has to stay cool because zirconia is very finicky, right? It's, it's, um, it's like, you know, it's, it's, uh. Like a clay pot and just the littlest thing can, can impart some weaknesses and expose

Part 413:35

that and, and crack and fracture and long-term too. It's not something that would happen right away. Yeah. ▶I can really see from like the anxiety standpoint from the patient that them thinking like this will be two appointments, three appointments, and then I'm done and I never have to like worry about this again. You know, I can see that mindset, but I feel like they just maybe don't. You know, the understanding that it's a team, we're going to work with you.

It's better in the end. It's kind of just that fear, like immediately, like let's get it done and over with and never think about it again, which again, I think long-term having a few more appointments and trying something in is what's going to give you the best results. Yeah. And that's a perfect point to say that when we did this on the day of surgery to get the records proper, the post-surgical records. So then. Match with the pre, those were very difficult because now you're adding time again, you're adding a lot of time to the surgical day, which can be overwhelming to the patient.

And when the goal is to minimize that, even a long surgery, you know, one of the things that I absolutely love the most about our protocol is it's the little snippets. It's two hours on the day of surgery. It's 30 to 45 minutes the next day, 30 to 45 minutes. The next day, none of it is overwhelming to the patient and that, that is a big factor. So you have, you still spend a lot of time and the other side, right?

The, the dark, the dark, dirty secret is sometimes your machines break. Yeah. Sometimes your, uh, designer doesn't show up on time. Sometimes they're sick. Sometimes they're angry. It doesn't, you know, there's, there's a lot of things that go into it. And so. We used to run into occasionally, not very often, but occasionally the teeth aren't done on time. And so they have to wait instead of being at 10 AM, that's at 12 and one and two. ▶And so there's another aspect where you can really expose your shortcomings really quickly to the patient and lose confidence.

Yeah. Let's say our double is two hours long. What would a day be like with that? Like start to finish. So surgery day. A double for us is generally. Two hours, including the information, a double arch top and bottom for a conversion denture. It would generally be somewhere between depending on who's doing it and how good the records are ahead of time and how they do it is six to eight hours generally. And when we were doing, uh, straight to a finished product, I want to say it was about four and a half hours start to finish.

So about twice the amount of time that we do now. I want to think. And I feel like. I've heard it or I wouldn't just like come up with this mindset, but I want to say that I think patients coming to us in these little windows each day is like kind of therapeutic for them. I kind of feel like we're like exposure therapy for them and it's really good. Each appointment where, you know, I mean, it's going to be tough cause it's pain and surgery, but we're really nice and they're comforting and they're having, they're seeing it's not as bad as it is.

And I, I swear by the end of it, I think they don't have the fear of the dentist as much. I mean, Hey, we all have, have it, but I fully agree. I think it makes them. Feel better. ▶If you were to, if I'm afraid of flying, you put me on a 10 hour flight, eight hour flight. That's not going to be, it's not going to be pretty. I'll tell you that right now. But if you put me on these little one hour flights every few months, I'm going to, you know, get, hopefully get over that fear.

So I'm hoping that's what patients are experiencing. I think it is. I think we do a pretty good job of, of conveying that to the patients and getting them to a point where psychologically nothing is overwhelming. And that plays. Plays into the effect of how the results go. Yeah. You can be more successful when a patient is of a better attitude towards how the results, you know, an optimistic person is going to get better results. Yeah. And unfortunately that's just the reality.

Yeah. It's this weird world where when you start saying, Oh, I'm going to have an implant that gets lost for whatever reason, you've kind of just willed that into the world. So when, if we can, get a patient to have some positivity coming into the procedure, generally it's going to go well. And so if they're positive towards, I'm going to get to pick and I get to be in charge and I get to, to play the role that I want to play and they won't go past that without my approval, it can be a very comforting thing and allow them to be optimistic enough for cases to go well.

Yeah, I agree. The, the other dark secret of the 24 hour final. That I'm, I'm not claiming that I've been in the other offices enough to really, truly know, but I believe from what I know that we are generally myself and my old business partner, we're generally the only offices truly designing fully from start to finish a true 24 hour fully made prosthesis because there is a cheat and that cheat is out there in the world.

Mm-hmm. Mm-hmm. Mm-hmm. Mm-hmm. Mm-hmm. I don't want to name anybody by names, but you have to be careful when you're picking in 24 hour final location, if that is what you want as a patient, because what will happen is they essentially come out with different sizes of teeth and different shapes of teeth and they're already pre-made and those pre-made arches then get retrofitted to what the specific patient detail is. Mm-hmm. And so guess what though? Mm-hmm. Mm-hmm.

Mm-hmm. And the patient's not going to know. Yeah. And the patient's not going to be told it's anything but custom if they get asked. Yeah. Yes, it's custom. Of course, it's made to you. Of course, it's custom to the implants. Yeah. But the actual teeth, the actual design, the core data, what you're manipulating and the customization of it is very, very limited by retrofitting to your standard sizes. Let's say I'm a patient listening to this, like what is something, let's say you go to

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one of those 24 hour, like what do you ask? Ooh, you just had to ask the hard question. I'm so sorry. I don't know what, I actually don't know. I'm just here to expose, not come up with the questions, I guess. Say the names. Yeah. It's, it's, and that for me, I would, I, it's hard to think about a scenario where I would be okay with that as a practitioner. Yeah. Maybe, I guess, if I was really happy with the results.

Yeah. I mean, I guess as a patient, you can look at photos. I mean, I feel like for us, I mean, a tail sign is. I mean, if you were giving us a photo of, let's say that you loved your smile when you were 22, we can, our designer will recreate that photo. ▶Like we'll re as best as he can, of course, but that's custom. In my opinion, that's customizable. Very. Maybe that's what they ask. I don't know.

It's tough out there. It's frustrating. Cause I do know, I do know there's plenty of little buttons you can push to alter and manipulate that person to thinking that it actually was custom or even if it was, let's just say, um, well, let's go back maybe five or six years and we were designing as we were, but maybe the patient wanted to make a change sort of last minute after the teeth were already made. And it was just like pointing the canines we'll say, well, you can alter that beforehand and you can alter it before it gets processed and put in the patient.

So the patient may think that that was dialed in for them. Um, but now their core data is not the same. Yeah. So that can be a little bit of a, of a mask you can pull too. Cause I could go in there and adjust the canine real quick. And then the patient thinks that the file is fixed, but then if we made a new one, it wouldn't have been fixed. And so in establishing a protocol and then establishing a, a world that everyone can be happy in.

For me, it's really important that everything is from the ground up. Custom in that file is as representative as the patient's teeth in their mouth is absolutely possible. And it's, it's frustrating for me to see the world of full arch dentistry because it's a slippery slope. You know, if I'm competing, let's just say there's another, I'm not going to keep calling out the 24 hour centers, but they do do that shoe box. I call it the shoe box method.

Where let's just say there's another competitor that's seven days, but they're using a shoe box method of some sort. That's frustrating because what do I advertise on that says, no, but we're better. ▶We actually make it custom because they can use all the buzzwords, custom implant supported quick to final. They can use all those buzzwords. They can use all the marketing techniques. And I think that was one of the funnest part of developing our style was kind of the way we've been doing it.

of breaking the mold because at the very beginning we worked very hard to be marketing ourselves as sure you don't get teeth on the same day but we're so digital we can get you to a finished product and so we relied on bragging if you will about our digital abilities well anybody can put a computer into the process to say they're digital yeah i was watching a there's a local dentist that was bragging about how how digital they are and the latest in scanning equipment being a nerd i know that that scanning equipment is not the latest and greatest that they had on the commercial and it's frustrating because that person then gets all of the benefit of marketing towards it a patient gets looped in and maybe likes them and they don't even know whether or not that's the best they've just been told that's the best i think it's just research and that gives it a lot of times it's finding a you know a lot of times it's finding a somewhat nice dentist that you you know have a little bit of comfort with and then unfortunately you get into you know you don't want to not believe anyone do good i just think doing research from start to finish and actually if you're somebody that was looking to get this procedure done it's the best but a lot of people won't know and unfortunately that's just up the dentist to hopefully be as upfront and honest about what they can do but i i think seems like everybody's has really good technology nowadays or at least they're bragging about what patients think are really good is really good technology and this i tell patients every single week in consults i don't envy you trying to figure out and wade through this whole world because there's a guy that says that he's digital and probably has terrible results and really is just used a computer on the lab script and then there's other guys who are amazing at what they do and they are all digital and so it's very hard for a patient to discern where and what they're doing and i think that's what to do and how to go about it yeah and and to to touch back on one of the coolest parts of rethinking our protocol was realizing that if i rely on marketing to digital only everyone's going to even if i have the best of the best of the best forever and ever i'm still not marketable i can't hold myself out as different marketing wise because they're all going to have a computer based in the same in in some point in the in it's not the patient's fault but they're not going to be educated enough to to discern between the better version and the less better version and so digital is not going to be a great marketing point for forever yeah and um so that was what allowed for us to really kind of break the mold and say okay but what's our staying power what's our core beliefs and our core values that really hold us out and at the end of the day it's it's being human and making decisions together with a patient not forcing them into a scenario and keeping them comfortable and allowing them input while still using a variety of techniques that are the most efficient some are hand and some are digital and we try to put together the best flow of digital machinery to to get to that result and things are constantly changing there's three main models that we're trying to put together and we're trying to put together the models of they call it photogrammetry photogrammetry if we haven't explained it very well before photogrammetry is what allows for the accurate data of where the implant is and it's a scanner but it doesn't the best way to describe it maybe is most scans are built of a lot of pictures being stitched together and uh representing what it is because it's all the pictures and photogrammetry more or less is a scanner and it's a scanner and it's a scanner and it's a scanner and it's a scanner takes pictures of a known flag we call them a known marker and it says i know what's at the bottom of that and i have enough pictures to say exactly where that is and so photogrammetry does not allow for gum tissue scans or tooth scans because uh the gum tissue is always going to be different it's not going to be a known thing and so you have to do the scan that you take for gum tissue and teeth is all stitched together pictures which is less accurate or not accurate enough to then turn into implant position yeah and so we use a thing called photogrammetry which gives us the exact implant position and there are three main units on the market i've used all three now yeah and and use them heavily and believed in all three each time yeah so things are constantly changing in the digital world and it's not just the to set it and forget it you kind of always have to be pushing the envelope but i don't as long as the data and the files and the results that we're getting are better and better i don't have to worry about bragging about the next new or who else has the next new because we get to brag about being very personalized and being very relationship based for sure and i i realize that probably alienates a few people because they probably don't want

Part 628:20

a dentist all in their business and don't want a dentist to be their friend i want one to be my friend i think it's not nice but it's not necessarily about just being friends it's about working together in a forward manner yeah it's having everything the perfect package do i want a dentist who's super nice like ours and cool like ours yes but i also want someone who's going to have that knowledge the technology the experience everything so it's all a good package but yeah it's great it's been a it's been a great uh career and process to really figure out the right protocol going to a finished product was something like i've said before wasn't approved nobody thought that that was a good idea and everyone shied away from it i think i've said this before on a podcast but i can remember when we first started doing 24-hour finals i can remember going to meetings with other dentists there specific meetings for full arch hybrids and hanging out there with with my old business partner and trying to talk to dentists about how it was possible and what the advantages were that we saw and we were just literally pariahs i mean we might as well have you know had some offensive symbol on our head or something does not did that frustrate you at that time it was very frustrating because you're trying to i was young in my career at that time and i was having colleagues that i wanted to help and give a benefit to or or see get better and and see overcome some challenges i was trying to give them a solution that helped with a lot of things and it was a big eye-opening experience that not everyone wants necessarily things to be improved they want things to kind of stay the same or they want to believe that they're the only ones possible to get a good result yeah and that's something i um try to keep in mind as well there are plenty of centers that i'm sure do an amazing job and we'll say maybe even do a better job than us i'm not sure i haven't seen them yet but i'm sure that they exist and they maybe care more about xyz um but i guess the the biggest thing is sort of from the top to the bottom we try to impress on our patients and our staff how much we care about their result and how much we've tried to assemble a process that is very straightforward and very um can give them a peace of mind about how things are going to go yeah and for us 24-hour finals just gave too much of an impression of too much speed not enough patient involvement and then also was your system is running at 100 miles an hour if you're doing it right because everything is timed out to get it perfect yeah something it's human nature something's going to happen you know it can't always be on time and perfect in that scenario i can only imagine like you said one person is sick for the day which is life and then what absolutely yeah right and you and it could be just the guy that delivers the teeth yeah that's sick um the the part of the of the process the 24-hour kind of going back to the to the equipment and the machinery i tell patients all the time i still have all of all the equipment that i have is what i had when i did 24-hour finals or better and most of the equipment that a lot of labs and other doctors have for their own in-house labs and such they're all that's all equipment that can get a final we can get a final now to you if we do surgery at 8 a.m that final can go in the mouth by five or six or you know sometime in that day we have that capability our machine is our machines are more than capable of accomplishing that along with hundreds of other offices it's just a personal preference of what that timeline is going to be and so 24-hour finals used to take a lot more finesse of putting machinery together and now it's sort of standard now kind of all of those machines kind of accomplish those tasks so it's not that the person that does 24-hour finals does it because they're the only ones that are capable in my opinion it's that they're a young enough company that they haven't really truly learned the lessons or at least getting away with enough corners cut that they can get away with it yeah i think as a patient i would feel good knowing that you've you've done that you've tried it out and as you know does it work yes was it your favorite no it's not like you've never you know if you said oh i don't like those other guys and i've never even tried that like well you never tried it you you did you tried it out you began that to a to a deep deep level yeah tried to get the whole world on it yeah and um luckily and i'll tell you actually the biggest just for an education in terms of of where 24-hour finals used to be and where they are today when why we were the only group that really could do it for a while or one of the only groups is that you had to have milling machines that cut the teeth and you had to have milling machines that cut the bar that held the teeth together and so where the implants get screwed into or where you where you screw into the implants traditionally was mainly a full titanium bar that went from side to side you know all the way across the arch and combining those two technologies so that they fit together and that they got glued together and that they looked good and performed well was a kind of high level experience and the one main competitor that was out there at the time they were doing something called the bar but the bar was the only thing that was custom made that day and then the channel or the groove that the teeth sat in was uh cut such that they could essentially refit and re-glue it which gives you a little bit of inaccuracy and wiggle room and it's not perfectly made and so one thing that we were really proud of was the connection that we created between what our teeth our machines were cutting and where the the bar was was being made but in this world you now have two pieces that need to be perfectly made to fit together and when they're perfectly made both of those machines have to operate and the person has to put them together and they have to be there to to put them together and where things changed quite a bit with the whole world was when we started going and having zirconia that looked good enough yeah this what i'm talking about was other materials it didn't it wasn't as good looking and uh it was a either of uh nanoceramic which was a plastic that had ceramic particles in it or it was a pmma which really isn't strong enough to to be really long-term finalized and where i can remember where things were really changing was designs got simpler when we got to go to zirconia and the zirconia looked good enough to use as a finished product yeah it used to look like this coaster it was just a plain white life in it no life no uh variety of color they call it so there was no clarity and no um no see-through aspect to it and so when we finally got the good looking zirconia we also got the ability to not have to have the milling machine that cut the bar operational at the same time and that's where you had a little bit of a a wave of more people doing a straight to final because it became easier to accomplish the correct file and get to a finished product yeah and now we live in like heaven basically because the file that goes into the 3d printer that we're now printing prototypes out of is the same essentially the exact same file that goes into the zirconia machine and it's if we go back 12 years in my brain or 10 years in my brain that's what i was hoping for is it's it's literally a period of heaven even when i first started what three plus four years ago now it our printers were different and i remember the quality of our prints then and i remember the quality of our prints then and i remember the quality of our prints then and i remember the quality now i remember when they showed us the first print on the new on the new print machine i was stunned so i can only imagine what's to come but i can imagine from your end starting in school and then seeing everything progress but i think it's just about sticking with the what's the latest and greatest technology because you can get left behind very fast yeah it's it's a it's a dance between staying on the latest and greatest and staying a little bit behind yeah we're in the middle of probably switching over our scanners for the photogrammetry for the implant positioning because number one they're more accurate but biggest uh is that right now when i take a picture and i ask the computer to calculate where the implants are and i give that over to a designer i don't have anything that says that my machine is calibrated correctly other than going through the steps and capturing the information to then turn into a file to then go into a patient there's a lot of steps that could have been messed up in between and we would have to go through a lot of testing to figure out if if it's calibrated properly or not this particular one that we're probably switching to or in the process of switching to has the ability to take a scan of a model that's been calibrated and compare it to the data that the computer is spitting out and when it compares it it says your machine is messed up right yeah which is really cool because now i as a practitioner know i'm giving good data if i can take a good scan of you and i'm worried about it being off i can then take a scan of the model and ask essentially ask the software and say is this correct and i can say yeah it's it's correct within xyz amount which is really cool because it allows us to target where our areas of inaccuracy are another thing that's really cool is that once the machine makes all of that let's say that let's say we take a scan let's say that you have a full arch we take the scan we say oh i'm not sure if that's that scanner is working properly let's just make sure we scan the model and we say oh yep that data was perfect to lilia well now i know that from the file to the finished product is a whole separate things that the set of things that could be a little bit inaccurate well when they make your zirconia we we now have flags for this machine where we can put them in the underside of it and we can put them in the underside of it and we can put them in the underside of it and take a scan of that and it will tell us if how much it matches this the original and so we're going to be able to much better pinpoint things that are not accurate or perfect yeah because another aspect of technology is there's always a fail point in figuring out that fail point being able to to really limit the exposure to the problems and being able to dial that in yeah it's always you know we've all gone in and we've all gone in and we've all gone in and we've all gone in and we've all gone in into a computer that's worked for the last three years and then you go to turn it on and it's messing up and you turn it off and you turn it on and the next day you turn it off and turn it on and it works fine yeah technology is can be finicky so it's about making sure you put together reliability being able to identify where your weaknesses are or where the problem became and being able to hone those in we had a this is a side side this side story when i was in between undergraduate degree and dental school i took a year off and i moved back to michigan and in michigan there's a big mlm of sorts called amy and they have a really big production facility and one of the coolest things about having to take a year off i was only 20 i would have only been 20 in dental school at the time and so even though maybe my test score wasn't absolutely perfect it was good enough to get in they mostly came back to me and said you're going to be 20 you're not going to really fit in like why don't you take a year off so i was mad at the time or upset or disappointed you know emotional over it however it was really cool because i actually got to use my degree my degree was in micrology and i promise the story has a point so i worked in this production facility for a year and we did lots of contract things like we did all of uh johnson and johnson baby lotion l'oreal like the kid um uh shampoos a lot of different stuff that were from a lot of perel perel shampoo they produce all of that there and so there were big manufacturing plant that it was a big manufacturing plant and we had huge lines of mixing we had to test beforehand of the raw materials going in and the the stuff coming out and where is the bacteria is it safe is it not safe so i'm working there for a year there you know the fluoride mouth rinse act i remember yeah there was a big release of act times two it was the second generation of act fluoride mouth rinse and it was supposed to be this huge release there were grand opening scheduled on the whole thing right big product release and every time we tested it was off the charts for bacteria and we couldn't figure out what the heck was going on i mean we tested it for weeks and weeks and then we're huge they didn't change i don't know if this is true for all production but for our production we tested it for weeks and weeks and then we're

Part 742:21

they just they would keep producing it the same exact way um on the assumption that you would find out what was wrong and be able to fix it retroactively and be able to fix it so that their schedule didn't get messed with yeah so we had warehouses full of this stuff tons of it and we couldn't figure out where it was what ended up happening was the original bottle was had a sticker that was essentially slapped on it and what they had done for the this particular one and is they shrunk wrap the whole thing so that the branding and the logo and everything looked more cohesive and sexy and so we i was part of the team and i had really nothing to do with like actually figuring it out but it was part of a team where they figured out we figured out that the the bacteria that was holding this whole warehouse up came from the shrink wrap the steam that was steaming to shrink wrap the steam that was steaming to shrink wrap the steam that was shrink wrap it was a dirty was dirty water dirtier than it should have been and that was where our whole problem was right all the way down the line was getting affected like delivery schedule release shipping all that stuff was getting affected and uh it's just part of that that the the example is that in manufacturing just the tiniest little thing can throw the whole system off just the tiniest little thing and so being able to nail that down we had certain checkpoints that we had checked a thousand times i went to the to the plant and checked the air samples a million times and we couldn't figure it out and just that little aspect was what had thrown the whole thing off so in putting this together you can get it done in 24 hours and do it well you can get it done in three months and do it well you can get it done in a week and do it really really really well just kidding really well uh but you know it's all about the the whole process because just your water can throw the whole thing off yeah and i think patients are already scared as it is so one thing that doesn't go right unfortunately is going to make everything that much worse for them and at least their mindset of you know dental spaces dental offices dentistry in general so yeah it's the integrity of it and it's it plays into the employee confidence i think it's the confidence and the integrity of the employee to relay sort of the salesman's message if you will and then it's that sales message being captured by that's actually how it went and then the manufacturing being able to actually manufacture it with that and being able to identify and advertise we do it right we do a full custom we don't take any of those retrofitting shortcuts we don't we don't bait and switch you and being able to stand behind that is very important more important than than the timeline 24 hours fine i'm very grateful for the opportunity to have done it i don't want to do it anymore it does lead to some frustration and some strife between

Part 845:30

patients not all but enough that that's not a world that i want and so it's not anything to do with the capability of the machinery it's not the capability of being able to get a good result it's sort of end to end how can you give your employees a good quality of life balance how can you give patients a good result how can you have a good quality of life balance how can you have a good quality of life balance how can you have a good quality of life balance how can you get them a peace of mind and putting that all together is where we kind of got away from that full or that that 24 hour final yeah definitely pretty wild stuff crazy stuff a lot of people don't know it's and that's the that's the intention of this podcast is to sort of not talk bad about other people but to give the consumer something to think about and and we didn't give them a whole lot of to we gave them a lot to think about but not a whole lot of answers in terms of what to ask them and we didn't give them a whole lot of answers in terms of what to ask them and so ask because i've thought about it it's it's hard it's so misleading and so entangled yeah it's almost impossible to ask a question that would be telling just research and go with the gut go with the gut always gut well liz i appreciate you coming on this and uh giving some feedback and discussing this with me and uh i'm sure we'll have you back very soon thank you thanks everybody