Ep. 38: Why Timing Matters: The Done In One Full-Arch Timeline

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. With us today, we have Erica again. Hello, Erica. Hello. And we have Dr. Sarah Laks. Hello, hello. Welcome, doctor. Thank you very much. Dr. Laks is the restorative doctor that we have that attends the clinic and does everything above the teeth at the Boca location, the heart and soul of Dun & One.

Yes. And today, we're going to be talking about time and not just specifically like what our timeline is, but more or less what the value of time is to patients and what that means to their livelihood and their lifestyle. And, you know, it's something that we've gone over quite a bit, you know, talking about our timeline and why, justifying why we do... and why we don't do 24-hour. It's very hard to disseminate that, by the way. You know, somebody told me, I don't know, it was Monday on the way home from Jacksonville, ▶Lilia and I were talking about it, and a patient was asking why we don't do 24 hours.

And it's crazy. All of the stuff that's out there, it's really hard to justify. You have to justify it no matter what, even if you just... if that's the entire intention of your channel is to XYZ, justifying it. So, you know, for once and for all, we have the equipment, we have the technology, we could easily fit and be done with a zirconia on the same exact day of surgery. The problem is, or the reason or our justification of what we have changed is that that didn't give a good enough window for prototyping and working through and doing all of the...

special stuff, the art of Dr. Laks. And at the same time, waiting till the implants had healed at the end of that three months also didn't give us a chance to develop and play a role in how the gum tissue was going to heal. And it was an encumbrance on patient's time. And so that five to seven day window has been sort of the sweet spot. And what's great about it, and this is all stuff that we've hashed out many, many times, but what's great about it for me is the comfort of knowing that once I hand a surgery patient off to you the next day, it could be that set of teeth. It could be the next set or the next set. We're going to hit that timeline and that patient is going to get what they want combined with you, the restorative assistant, their significant other. Everyone's coming together. Everyone's making a decision.

So you sleep better at night and they sleep better at night. Right. So that's just a general premise laying out of the timeline that we subscribe to. It's worked really, really well. We've done it for at least about five years now. The prior four or five years to that, we did the 24 hours and that was really tough. We damaged a lot of teeth by adjusting them. If they were a little bit off, we would adjust them.

That was part of the discussion too was, well, what happened when the bite was wrong? ▶Well, you get to grind it in and the patient doesn't really know, but you're hurting that zirconia. Some adjustment is okay though. That's another one of those messages that's hard to get out there that as soon as you adjust something in zirconia, I'm sure that you've dealt with it. The patient goes, I don't want mine touched. But these days it's such a minimal type of adjustment. So usually people are fine with it.

Part 23:58

Yeah. They just didn't want hand pieces, but they wanted it perfect craziness. But that's not really, I wanted to hammer that out real quick because that's not what I want the focus of this discussion to be. I want it to be more of the real value of time, the real, what are we really saving patients and what does that mean to them from a personal standpoint? Right. So, and one thing I was thinking of as we were coming into this, you come from a large family.

Your, your family, I'm sure is always running here and there and everywhere for, for, um, the family. And this isn't a knock on family, but there is a lot of, uh, wasted travel time back and forth. And, um, you know, so, so you understand the value of say the value to your mother when she doesn't have to, when she, when she finally was able to have some kids with, with some licenses that could get themselves around. Right.

I'm sure that was a huge weight off of her, her belt. So that's kind of the, the stuff that I was thinking about was these encumbering things like Erica lives about, and used to live about an hour, 180 miles away, felt like it an hour away. And so you generally come in daily and that's a lot of time off your, off your plate. And if you could just snap and be here, um, local to where you hang out your work and such, that would make a big difference. And so for us, this was a big change because we were this, and we were the encumbrance. We were the children that needed to be taken to all of the different sports games. And, um, now we have children that have licenses that, um, reduces the time.

It's about how do you utilize your time wisely? Right. I love this topic so much because it's, you know, it's such a huge focus, right? A lot of people usually talk about speed when it comes to implants and full arch, right? Speed, how do I get it done in the quickest timeline, but it's not about speed or speed is important, but it's really about time and how do you use it? And these days, you know, it's about efficiency. How do you get things done the best way, but use your time the best manner. So I feel like that, you know, our, our window of time, the five to seven day window is like, that perfect, you know, it's not cushion time. Cause no one likes wasted time sitting in a car in traffic. Everyone hates that. But how do you utilize your time to the, you just hit on something that I want to draw out. Cause I hadn't thought about this speed is sort of a negative thing.

▶Speed can create problems, right? That everyone in the office hears me say the mantra slow is smooth and smooth is fast. Speed is negative. Can be negative, maybe not for a car, but it can be negative for something like this. It can mean a rushed job, et cetera. And so the quality of life that we're talking, isn't a speed issue or getting bragging about our speed. It's more about achieving that work-life balance and saying, you know, instead of being at work, we're at home quilting or doing something of our hobbies or painting or whatever. And so I feel like that's a good thing. And so I feel like that's a good thing.

But not right. And that work-life balance is the delineator versus the speed. Sorry. I just wanted to draw that out. Cause you said that it really kind of hit me. Yeah. And also, if you think about it, majority of our patients are coming into this with having gone through trauma, right? In the past, they're thinking about how many appointments is this going to take? How long is it going to take me? Cause they probably been through kind of hell, right? In the past. And it's kind of been drawn out and it's nonstop, you know, never.

And so, um, yeah, it's interesting to, to see how it's been, you know, just streamlined and we really don't have to worry too much about the things that, you know, used to be problems, you know, in the past. And, you know, the, the harder details about this process are kind of, uh, already dealt with, you know, for us because it was, you know, already so well thought out. So just an interesting little, it's, uh, it's, definitely the, to me is my protocol and such. So of course I have a loving relationship with it, but to me it was a big attempt at embodying the work smarter, not harder. There's a lot of stuff that we could work harder on and be less efficient and be much sloppier and not do as well. Keeping it simple, creating a system and a protocol, you know, Dr.

Hauer and I were talking just this week as well about how having a system eliminates all of the unknown in the surgery or a big portion of it's surgery specific such that the peace of mind and the calm that you go into with it, not only are you going to do better because you have a system to go into, you also don't have that unknown going into it, that nervousness or that distress. As the surgeon, the one calling the shots. So having, going into a game with a game plan is very, very important. Right? Exactly. And I think you said this once to me, I think right when I

Part 39:40

started, you said, you know, people are not going to remember what you say, right? The details, people don't really care about that. They care about how they feel during the process. Absolutely. That should be the focus. And it's also, you know, for us, you know, the providers, we want to enjoy this process. Also, it should be exciting. So I think, yeah, right. And so, so what I was saying to that was they aren't going to remember how much time you spent polishing their conversion denture on the day of surgery. They're not going to care how much you sweat over the color and the shape when they weren't there, uh, or even when they were there, they're going to care about how they feel when they look in the mirror and how they were treated when they were there.

And that's, that's, that's, that's, that's, that's, that's, that's, that's, that's, that's, that's, that's, that's a hundred percent what our MO is. And I would say that we do a pretty good job executing it. Great. It's true. From a patient perspective, do you feel like that is communicated properly, or do you think that the majority of patients just kind of see it as it's the steps that they do? If I went to another one, I would be going through the same steps. It would just be a little bit different flavor. Um, no, I think people are very aware of the timeline, you know, because it's a spectrum. You get the 24, you know, in a day places, and then the more traditional approach, which can, you know, be drawn out for quite a few months to, you know, maybe a year, a little longer of a process. So people are, they come in knowing, um, they have a sense of time. Um, but we, you know, stated in the, in the consult, you know, we, that's why we're so in depth with all the consultations because we walk them through the process. So it paints a picture in their head about, you know, why we're taking this time, why we're not doing it.

This way or that way, why we've kind of fallen in this like happy medium place. That's kind of perfect. And so once they understand the reasoning behind it, and it's not just, oh, it takes a week, you know, I guess that's just how long it takes when they understand it, it becomes kind of cool. ▶You know, I agree. And I think it strays even from the week's timeline that we put into this, but also just the chair time of that day that this patient is receiving. I think that they understand and see that every second that they're there, they're seen, they're heard, their time is respected.

Yeah. And that's actually, so, so long as we're talking about the investment of time, that's one of the major ones. And we do run into this quite relatively frequently with consult. They're used to such a consult being so quick and sort of boom, boom, boom. Maybe I'll see the doctor. Maybe I won't where we try to open up and you've got 30, 40 minutes an hour. If you need to with yourself or myself or whomever it may be, and that's where we take our time and let it all soak in so that we can, you know, on our side, select that the patient knows what they're getting into and knows where we all stand.

Part 412:40

And for me, that's, that's part of this whole protocol that allows everything to slide forward smoothly. Yeah. What do you think patients do with their extra time? Because let's compare it. You're legitimately in the old traditional method. You're legitimately committing like six months of this to be your life. You think of my mom's had a couple of surgeries this year, this in 2025. Um, she, her 2025 was rehab, surgery, rehab, doctor visits. Yeah. And that's how encumbering in a way it could be with the old way. Um, and so, uh, from, from that perspective, the patient gets a lot of, a lot more free time, free time. So, but there, you know, a lot of people are used to planning around their teeth, right? You know, I have to hold off on this cause I have these problems right now, or can't do that. They're always thinking about, you know, these things. And so it's nice now, you know, during the process, our appointments usually take under an hour, you know, for the try-in appointments day of surgery also is, you know, pretty quick, maybe around two hours. And then, and then, and then, and then, and then, and then, and then, and hours. Um, so throughout the week, you know, they have a lot of time to explore. It's great that we're in, you know, a beautiful area, but it's like, they're, they're getting their time back.

You know, they have their life again. They're like, Oh, I can enjoy. I can have fun. We just did one with Daniel travel concierge. And we talked a lot about that as well. Just the time that a person will have while they're here is probably a lot more than they'd think it's, this isn't this. We need you. For five days straight. And then you're done and you have this relief. It's, we need you a couple, you know, an hour per day. And that's about it.

Little snippets of the week. So what do you think is the fastest time that you guys will do a, um, prototype in and to the longest, what's the range? Um, like days, not an average, no, just in, in time on that particular like case try in, um, some of them are pretty quick. ▶Just cause sometimes give me a guess. The appointment, let's say would take 20, 25 minutes. And then let's say it's like that first try in, you make the final. So we're talking a couple days. So it's interesting how it, it can range, you know, depending on the specific case, depending on how, you know, picky someone is also sometimes they'll have a preference and we'll do another try. And so we can, you know, draw it out a little bit, but yeah, sometimes it's quick.

It's in and out, you know, they're in the office for under an hour for that day. They come back also under an hour for the next appointment and that's it. So it's pretty awesome. Yeah. But majority of the cases do take like the full five days. Cause when people know they have the time, they use it. Yeah. That's part of it too. I think is that people are, which they are, they're paying for this procedure to be done appropriately, which is totally understandable. But sometimes if we do, go to finals within like the first temporary or sometimes even the second temporary, they kind of question themselves and kind of question the process. Like it's too really enough. Am I really almost done? Am I signing off from my finals right now?

It's like sometimes too hard. It's overwhelming to believe. Yeah. And sometimes that extra day,

Part 516:14

just doing nothing, going to the beach, you know, living with that set of teeth, feeling it out, getting comfortable with it, and then confirming that they like it. Sometimes we'll do that too. If we have that time. So, yeah. The, um, generally the patients don't regret the money that it costs. We don't hear generally, we don't hear anything about, um, the cost, even though it is expensive. I always tell people I would fall over if somebody gave me a treatment plan. It's an expensive, big purchase. That's not what they regret. They regret not doing it sooner. The time that they lost having any teeth.

Yeah. We always get, Oh, I should have done this sooner. Should have, you know, could have found you guys sooner. Sometimes it's fear, you know, or life just getting in the way or finances, you know, a lot of factors are involved, but usually that's the case. You know, we'll hear that afterwards, which is a nice thing to hear. The, would you say it's fair to say patients don't want it fast? They want it done meaningfully. Yeah, definitely. Absolutely. Yeah. Like you said before, fast does not always mean good, right? Speedy. So, you know, I didn't say you said it. And then I got to, it hit me in the head.

▶There are some patients that are taken back by the fact that it takes a week though. There, so there are some patients that that's what they're looking for. They are looking for that quick, speedy surgery. Right. But I would say in comparison, like out of doing the consultations and the people who do have those expectations, I would say it's usually like one out of every 50 who, who have that kind of mindset who are like, let's just get it in, get it done, be over.

Right. It's such an interesting point. Cause it's a week. So it is a, you know, quick, it's, you know, but it's a week and it, it doesn't feel like that. Sometimes it really feels like, Oh, that was a week. It was like, you know, it was a month that we, you know, really dove into the details and the design and yeah, it was a week only. So it's cool. You know, the perspective, once you finish looking back, you're like, Oh, I'm really happy that we took that time that we didn't do it in a day that I, it didn't take a year. That one week was like, just right.

So it works beautifully. It's hard to, it's hard to impress that onto patients because they did make the choice in our doing this when this is available and this is the system that we use, et cetera. And they, you can't make a business off of, well, look how bad it would have been if you went this way because they never went that way. They went your direction, the direction that you're trying to say is better. So they, they have a difficult time looking at the other road and saying, look at all the time that I just saved because, and it's not their fault. It's because they went down the appropriate path. So, um, it's hard to tell them like, look what we saved you. Look at all the time that you get back.

Sometimes though, when you start explaining, um, like the reasoning behind it, right. We're like respecting the biology. So sometimes when you dive into like the scientifics about it, they're like, all right. So it can't really be done that way. And it's, you know, a little bit better to do it this way. Sometimes that helps just paint a bigger, clearer picture. Absolutely. It's very, um, it's very much like Amazon. You know, you, you get, I don't know, pick something headphones. You need new headphones. There's the ones on Apple may not be in stock all the time at the Amazon plant. So you may have to order a prime and wait two days, but you also may be able to order the ones.

Off of some Chinese manufacturer or whatnot, and you get them that night, right. But you order those so many at night, you're sacrificing the quality, but you get used to that. So that, that two days ▶I've gotten to the point where sometimes when I order stuff on Amazon, two days might as well be a hundred years forever, a hundred percent. And so I don't blame them for feeling that way because you get so acclimated to just this button, just full hammer all the way.

Down. Um, it's an interesting time is an interesting thing for sure. Yeah. These days, everyone is, you know, instant coffee. I think I had a teacher that once called our class like instant coffee students because everyone wants it, you know, done fast these days. So we still want that, but it's a great, you know, thing that we've fallen into this kind of perfect balance when, so that reminds me of just this last week, my brother and we, we kind of like share stocks and trade and such. And I was complaining to him about something

Part 621:03

not happening fast enough. And he said, just be patient. I said, I'm not gonna be patient. I watched Sesame street as a kid. I need it now. And it only gets worse. Our videos get shorter and shorter. Yeah. Attention spans, YouTube shorts, and now a minute and a half and tick talk 30 seconds. Like, yeah, we're going down to milliseconds. Yeah. But, a lot of our patients just, you know, they think back and they remember things taking a long time.

You know, they can't remember when they haven't been in pain or haven't thought about a tooth problem. And so giving that time back to them, they don't have to think about these things anymore. It's done efficiently. It's done well. It's just, it's more of a pleasant experience overall for us to, you know, the dentist involved. Yeah. I would, I would venture to guess you can correct me if I'm wrong and I'm not taking anything away from your job, but adventure to guess you have one of the most chill restorative dentist positions in America. Yes, I would agree. Do you agree? A hundred percent. I think it's pretty chill.

I'm proud of that. It's awesome. It's super chill. That isn't to take anything away from you. I would, ▶I would venture to say that you have one of the most, there's a lot of stuff that you have to get through and patients are in pain. There's those kinds of aspects, but from a dentist perspective, it's a lot of stuff that you have to get through. Will it work? Does this work? You know, screws fitting in those things, those types of issues that happen. Like we had the refresh last week where the part didn't fit things that are out of your control, um, can happen. But I would say as a day-to-day like reliability, I feel I'm so grateful for that. Yeah. I don't want that unreliability, which a lot of dentistry, you know, neither do patients. No one does.

And a lot of things these days, you know, it can be unreliable or a lot of gray area. So it's nice to have that, you know, solid ground, that foundation, knowing all these things that can come up. We know how to deal with it. And these are just normal day-to-day things that we'll always have to deal with. It's not figuring out how it's going to work. You know, another thing that Dr. Howard and I spoke about yesterday to a couple of days ago was he was asking me, he's, you know, learning the process. So he's kind of learning the justification, the boundaries, if you will, the bowling lane, um, the bumpers on the belly. Yeah. The guardrails. And so he was asking me about, well, you know, have you ever tried this? I think that this would work if X, Y, Z, you know, he's in that stage. And I told him, I said, every single thing that's out there will work.

You do a guide surgery and an in-sequence and do all the planning, I had to works. You don't do that. You do it the old way works, right? It will only for the most part, only work 80% of the time. There's 20% of cases where you bump something and you screw the rest of the situation up. So even in a best case scenario, 80 to 20%, 80 to 90% of the time it works, that's 10 to 20% that you have to scramble on and know outside of your system. And that's the thing that I love.

This system is it works a hundred percent of the time. It, there are things that we have to adjust

Part 724:33

inside of it, but you still stay inside the protocol. You're not having to think you don't have to have you, Dr. Locks do not need a full set of skills outside of Dunham one, just to keep yourself safe. Right. You can learn all of those skills and stay inside that box. And that's, that saves a lot of patient time as well. Yeah. And that let's say 20%, that may, you know, you go off the rail possibly. That's what really affects dentists and patients.

That's what ruins relationships. It's training. Um, and it really impacts people negatively. ▶And so I wouldn't risk it, you know, if I had to choose. So you did choose you're on our team. It's nice. No, that's, uh, it's been, it's been fun watching you develop and get your maturity. Now, you know, you're, you're a tenured portion, a person on the team, tenured, tenured, almost, almost two years. Yeah, that's true. You are coming up this April for two years. Yeah. April 1st.

Yes. April fools of 2026. Yep. So you are, um, a Dunham one staple at this point as well. Glad to be a part of it. I said the Danimal was the mashed potatoes. What are we going to give Dr. Locks? She's going to be something big. I'm going to go like, what's the dish? What's I was going to, I was saying like meat and potatoes, like steak potatoes. Yeah. I was thinking of Thanksgiving cause I wasn't too long ago. So I'm thinking like, um, I'm thinking like macaroni and cheese or something. I feel like Dr. Dan has to be the Turkey. I don't think I see a way around that one. Can I be like a piece of the steak? I love steak. You can, you can, you'd be the ham. Okay. Okay. The ham. Yeah. The ham. All right.

Wow. I'm not going to be the Turkey. The Turkey is the patient. Okay. Okay. Patient has to be there. They're the meat. I love them. Okay. Absolutely. All right. We're, we're growing this dish. We're cooking. Um, no, I appreciate you coming on and talking to us about that. And, um, I'm sure we will see you very shortly. Thank you for having me for everybody listening. You know, if you would like to save some time and have a peace of mind, et cetera, we're always here. Also, we haven't said this out in a long time. Number one, not medical advice, ice done on nothing on this show is anything but our opinions. But, uh, also if you have any questions, I think we're way overdue for a question and answer session. Okay. So let's try and get some questions from people, uh, and keep that rolling. Reach out. We appreciate your time and we'll see you soon.