[Music] hey there welcome to another episode of Beyond the Arches i'm Daniel Northook your host and I've got with me Robert ODM hello part of the uh DuninOne team uh as we talked about in the last episode uh we'll be kind of bouncing around with people and hanging out with them and just talking about all things Full Arch so um before we get started like subscribe smash that red button below all those goofy things whatever you want to say um but today's topic is going to be why full arch is the greatest dental procedure ever created amen yep well actually we're going to dial it back it's not that that uh stupendous but uh you got to get the uh the the wild titles for the likes right there you go um no but we're going to be talking about full arch kind of like how it came about and and a little bit more about what it is um and we're going to you know as we go down with the series we're going to talk about you know uh how an implant works and what is an implant and what what kind of people need all this i mean there's topics uh that that we could go on for hours and hours absolutely i think one of the reasons why I feel most comfortable kind of co-hosting this with you know uh part of my team is I think I could probably have one episode one podcast episode that goes about 72 hours of me just like rambling and going in different tangents so keeping me directed and focused on one topic will be sort of the name of the game for that's your job number one Robert sure um but uh but yeah so we're going to start off kind of just talking about um where this kind of procedure kind of came out from and um you know we'll just kind of parlay back and forth about um different views and things that you that you've read i mean Robert comes from um really having a good pulse on the on the um on the community right and um having a good perspective on what our patients understand and don't understand so you know if I'm I'm out in left field bring me back in yeah so definitely um Yeah so this this procedure specifically um a a dental hybrid procedure teeth in the day like we talked about last time oh I forgot i'm going to say this i'm going to try to say this every single time okay everything we talk about here is more or less off the cuff and is not is my opinion only of course it's the opinion of our done in one team and us so of course there's going to be caveats of course there's going to be a couple mistakes with dates here and there um we're not going to do a bunch of full research maybe occasionally on if we do some sort of historic and show some pictures but for the most part we're going to be shooting from the cuff and talking about from our experience and from our opinion so you don't have to agree you don't have to listen um but this is this is kind of where we stand absolutely so um where was I going into it yeah you were getting into it we were talking about oh so so full arch um this procedure where we're replacing a full set of teeth really the historically kind of comes out of um uh in 1998 there was a guy his name was Paulo Malo and he was a Portuguese guy uh and he established a clinic in Lisbon and um I think it was 1998 I think it was 1990 1990 I could be wrong too though somewhere around somewhere in the '90s the '90s Yep um and uh they what they what they decided they wanted to do is be able to give um patients that didn't have any teeth uh and didn't have a lot of bone an option to have those teeth and have that bone uh or have the the support to to support the teeth and and have a smile again and so essentially the thesis was let's put implants where we can and find the bone that we can and let's support those teeth or a denture or fabricate something that will be on top of it and that's where kind of the all-on four technique came from and it the what I find fascinating is that the original hypothesis was that these teeth or the patient base that was going to love this and flock to it was the group of of patients that were in dentures sure um that were very frustrated cuz you know as as everyone kind of know pretty much everyone knows uh a lower denture is almost impossible an upper denture is somewhat tolerable affects flavors and things like that but um a lower denture is almost completely intolerable and so the thought was hey we have a bunch of people in dentures they're angry they're over it they're going to flock and they're going to line up in in droves and what we have found is while we still get patients with dentures here and there um that wasn't the bulk of the of the community right and so sort of that initial push towards marketing to patients with um dentures uh was sort of not what happened to be what our patient base is but that's where it really came out of was this it wasn't hey how do we make a bridge to replace Jimmy's teeth cuz he has them now and we need to replace them later um it was more a procedure that was based on this guy doesn't have much bone let's put some implants in here where we can and see if we can support the teeth to get him out of dentures right which I find sort of fascinating that is interesting i wonder if you know um when they've and can I just say imagine being the first doctor trying this out but I wonder if they started with like multi-unit bridges or if a full arch bridge was the idea from the beginning you know yeah um I don't know the answer to that question the the multi-unit came on the scene really since I've been in in the business oh really um yeah it was more um there was an external attachment um but I'm not sure if it was a custommade abutman or a multi-unit and that is something specifically that we will talk about probably later today a little bit um as we get into um how they ended up a different procedure how they ended up starting with like doing zirconia bridges and how we've kind of all paths have have led into hybrids right um but that's that's an interesting question i don't know the exact answer to that yeah so yeah that makes sense that you know feels like you're kind of limiting yourself to people that are already without teeth yeah and yeah in in in my experience at least um we get a lot of denture wares of course and this is the ideal uh procedure for somebody in dentures of course but I don't know it feels like to me people that have already made that switch to dentures um they learn to tolerate it a little bit more because I feel like there's that I was going to ask you do do you know do you know the reason why and yeah you're you're right on I feel like once you get over that initial hump I mean we all know our grandparents were in dentures for 20 30 40 years but it's that getting used to being in dentures it's a real challenge for people yeah um so you if you could avoid find a way to avoid that alto together and go straight from you know having teeth which granted not not good teeth but teeth you can at least chew right not gumming food um to to something being replaced immediately that's a fascinating concept yeah on the denture note if you find just as a you know running a dental business if you find somebody that is good at dentures they're few and far between now because we don't do them the same way um the old techniques really required that you kind of really knew what you were doing right um and so that's a little bit more or less a lost art getting more and more to be a lost art sure um but if you find somebody that's really good at dentures you have found yourself one of the most patient amazing skilled artistic people in all the world because it is a true art i mean you're taking let's call it I don't know the equivalent of $1,000 for a denture i don't know how much a denture costs uh for patients or how much it used to but right let's say it was $1,000 so maybe the the equivalent of a crown or two and and these p these patients are uncomfortable it's like wearing a bad shoe right and and they come back every time that shoe pinches them and it's daily and it's minute by minute by minute right everything you eat hurts your shoe you know right if you have shoes that that hurt you take them off and you sit in the chair but you can't always do that in public and so the people that can really get a denture fitted and they can get it to get suctioned and be comfortable those are true true skilled masters of of the craft for sure yeah i've always heard that in dental school that's the part that everybody So it's required that you do that aspect at some point in dental school right yeah it is and it's it's very trying and difficult and and the patients right like part of and this is another topic we'll talk about at some point but dentistry can be really frustrating because and it's not the patient's fault but we're doing things that they don't want to have done right and we're kind of forcing it on them or they they they're in a situation where it has to be forced on them and and you're trying to get through it together but that frustration creates this barrier that just it's like hitting against the wall all the time and so it's it's it's a fantastic thing to see a denture a true denture master get a denture in there right when when we were in dental school for that portion um we had to fit them in in our school uh and go through all the steps and all of that and let me tell you when you get out of school you're not any good at dentures right like by no means are you competent at dentures right uh but they did have us go to the VA and we had to spend maybe like two or three weeks there and and kind of shadow and specifically where I ended up I don't know if that was true to everybody but where I ended up was uh following a guy that all he did all day was dentures and it was amazing what would take me 2 hours to do poorly was six minutes for him right and and did amazingly right and and like in that nature getting a little bit off topic again but um in that nature the people behind it the the the lab techs that if we're hiring somebody that's really good at setting teeth and doing a denture or or doing denture teeth um you've also found a master of their craft so that this V story I'm telling you um the people that worked in that lab in the VA it was this just thing of be beautiful symbiosis it was the lab techs they they um they'd have one tooth put in and that was it and then they would just set the rest of the teeth on it cuz it would just follow that and they knew where it was every single time it was pretty incredible to watch um but yeah that frustration that that um annoyance of of being in a denture most of the time people kind of get used to it you know they they it's it's a thing of comfort cuz they know it now right they they get through that hump and they get through that frustration and then they kind of know it and and then it becomes scary to leave because leaving it means some sort of surgery or something and so for the most part that was sort of a dead exercise right so that that kind of didn't hit true and then when I was in school um that kind of started to explode a lot more in the 2005 to 2015 era um and and in that time we started to get better made um uh implants for this procedure uh they were uh stronger right they they could be smaller so they could in um grab on to smaller amounts of bone and do a better job right uh and then the parts started to fit kind of better and start working better and and I kind of am lucky in the fact that I caught the very beginning upswell wave of this um not for the chance to open my own business and do this but I've gotten to see sort of all of the phases all jammed into one right if if I was earlier I wouldn't have sort of seen this part because I wouldn't have the digital part because I wouldn't have gotten into it as as early or I would have been at the tail end and if I had gotten into it later I wouldn't have known all of the other parts of it right the the the nuts and bolts of it so that period right now is we're starting to get into this like kind of sort of mature phase of of hybrid dentistry um but the in and in doing that essentially this was always because they already had a denture to work with mhm there was a lot of different ways you could do it i mean you could just leave the denture in you could put the implants in you could leave the denture uh after 3 months of wearing it um they would come back in and and this in the tale of me having seen most of this I've done pretty much all these different ways this was the way that I very probably in the first 50 cases maybe I did 15 of them this way right um which is burying the put the implants in put a put a little cap on the on the implant and put it underneath the gums and let the gums tissue heal over patient would wear the denture for three months and then we would come back in uh and and uh uncover them uh you know uncover them and and do a little procedure there where we we're playing hideand go seek with the implant that was always a lot of fun and um then we would put the abupman on right and the abupman is basically uh what is your attachment right it's your it's the the the implant is your support it's your structural beam and then the um the abutment is essentially the screw that your picture frame is going to hang off of and so it's sort of that translation right you've got the stud the the picture frame screw and then the picture frame right and so the abutment's sort of our our uh screw by the way since this is only two episodes in I speak in a lot of metaphors sometimes that helps people and sometimes it doesn't no that's that was a good metaphor but um we would do that and then uh we would take some records we take some impressions and those impressions uh would be with very spe specific pieces that would tell the lab how to pour it up in stone and then start converting it into whatever you wanted to right uh or however you were going to build those final teeth usually it was a denture just a crappy acrylic denture and that was sort of molded over top of a custommade titanium bar and when I say custommade titanium bar I am sure what you are thinking of is a milling machine and the grinding sound and all of that but no we're literally talking about casting it in a furnace melting metal down and replacement all of that stuff your typical real cast um casting a form and so wild wild times right that we take for granted milling machines nowadays yeah yeah we stand we stand on the shoulders of giants for sure um but uh so that was sort of the end to end procedure right and and the difficulty with that is um working away from the denture patient now we're kind of into more what we would think of as a traditional um hybrid patient which is kind of anybody that has failing teeth or has some significant issues of some sort or has already lost a bunch of teeth or maybe they don't have teeth right they can still be denture warers um that that patient um would go through this sort of long torturous process right um and that was a very frustrating time and that that's sort of why we've kind of worked away from that as an industry is it's not that it doesn't work right like we talked about last week everything we talk about whether we kind of diss it or not it works it's mostly going to be to the standard of care find somebody that cares about you and put some effort into their work but it's not about who's better or best or or or that kind of thing it's um it's going to work right sure the the other side um Dang I just forgot where I was saying um I don't know but to sum that little part up right there I think you're saying like you know the journey is can be different for everyone yeah exactly right the end result you're going to get to regardless of timelines or materials or whatever you're probably going to end up in as long as you trust the the professionals that you're working with and and they're going to get you to that to that end um how you get there is just a matter of clinician preference you know different doctors have different ways that they feel more comfortable doing things and what fits in your budget and your timeline as a as a patient yeah the the frustration side is something that sort of paved the way for all of these better things to come along right that's that's why our protocol is the way that it is the reason why our patients go through this smooth process is because they're standing on you know the shoulders of giants right for sure they are standing on the frustrations of old patients some of who even just being in uh the the few years five six years you've been with me you even caught the tail end of that where things were still frustrating and they were the smoothest they had ever been right and so that was always very frustrating to me an aspect of sort of this historic episode of where we're going through kind of like the rough timeline is that we're when you would see this patient right after and and you know obviously we only talked about sort of the all-in form bearing it that transitioned as our implants kind of got better and people got a little bit more needy and we already had the denture we would cut it apart glue it together so they could wear that right the immediate load we'd put the um immediately they could kind of choose do some sort of food something yeah that whole process could be like endlessly infuriating and the only time that you got any sort of positive feedback was right away was day one was the was the reveal right the the pictures and the and the videos that everyone's seen on Instagram of the the guy's a firefighter and he's never seen himself with teeth in 5 years or whatever and then he's crying and all of that what they never saw was sort of the other side the three months of just annoyance and this sort of battle and these walls getting put up between dentist and patient and that was absolutely the fire behind us us tailoring in our protocol and making it a lot more straightforward and better um and I'm sure a lot of other people as well is is eliminating those frustrations yeah i from my time here I will say that a lot of the things that are in practice with our company now were dictated by patient experience yeah so I feel like our journey has kind of been a microcosm of dentistry in general because from what you're saying a lot of these changes were implemented to make the experience better for the patient yeah and I feel like if you prioritize that you're going to do well yeah the rest comes yeah but being able to do it with the right tools you know this if let's say that I knew what our protocol was going to end up being in 20125 back in 2015 uh what would that have changed nothing right because it requires that sort of long right same thing with like AI if we knew how AI was going to work back in 1995 we can't do anything we don't have the computing power we don't have the pieces we don't have the storage space we don't have all the stuff ready to go dreams we got dreams so it all kind of comes along together and it's it's been a fun journey like I said I've been able to see sort of the like the making of it and how it's kind of developed and so it's it's actually it's pretty funny cuz I'm like now the old guy right i've got my general dentist that works with me is like "Oh my goodness you used to do this." Like right tell us Grandpa what's tell us another story about the olden days with casting a bar that's how rapidly I feel like things are involving are evolving is you don't even have to be 5 years out and now you're old school it's wild knowing knowing that history has been been pretty fun but you know full arch is is a fantastic procedure because it does it now it doesn't just fit denture wares right if this just fit denture wares we'd be leaving alienating a whole another group of people right and and this is a very I won't say all-encompassing because there's a lot of things that this you know um disbar or you know preclude you from being able to do this i mean where it's not a good idea right i'm not going to get a a done in one um but if I lose seven teeth I might right it it's situational and it and it requires the uh dental professional and the patient and the team to all kind of come to that conclusion and make that that decision together but having it as a tool in the tool belt does kind of make it the greatest you know sort of procedure not to discount the other procedures totally fine there's a lot of really good clinicians out there doing really good work and they're building doing some miraculous stuff building bone and supporting teeth with single implants and those kind of things um but this is a really good sort of catchall whoops so this is like a really good catch-all that allows people the the option right it's a backs stop and and when I started going all the way back you know to when I was sort of learning about this stuff they hadn't made it into school yet where it was taught as being a viable option because there really wasn't a lot of timeline there weren't a lot of like sound procedures there wasn't like a a compendium referendum decision on where things need to go or how they how they go and it was really viewed as this like very very very last resort after you're in a denture forever put them in this and then when it fails just put them back in a denture and hope they don't you know hope they don't come and shoot your office up right um and and what's been really fun for me is seeing how that's not the attitude we should have at all and and actually seeing it change in the public perception but also in the dental perception right the tides are changing people are warming up to it and it's not a procedure where you're finished and then you're screwed after you lose an implant and you never can do this again right are there cases that are are are that go south that are bad yeah of course right we all live in a human body i say that a million times but at the same time it's one of the most straightforward easy uh you get a lot of stuff out of it too you know you get a good bite you get health back you get u a good look right and so it is an easy tool to reach for right the problem comes and and what the guards of of dentistry are trying the naysayers of of full arch are trying to do is they're trying to safeguard dentistry so we don't just you know by the time you're 18 everyone just gets it right well that's predatory that's bad and and so specifically for us the way that we talk to patients um is very like holding the hand here's the good here's the bad totally your choice right and and patientwise the um scope and the broad scope of people right just the personalities and the types of people and the background and the rich poor you know all different races you name it um they they that's all of our patient base and it's just filtering that out and working through it together right um so yeah I guess in the beginning we said it's full arch hybrids are the greatest dental procedure ever created and I guess we kind of backed off of that because we don't want people mad at us but it kind of is i feel like as a you know non-dentist kind of an outsider looking in it always blows my mind that something like this is even possible and I think people really lose sight of that and I have to remind some people you know what 40 years ago from from 40 years to the beginning of the human species nothing like this was ever possible like it's really easy to lose sight in the world we live in today because we take a lot of things for granted the fact that we can pull up our phone and find any bit of information human knowledge of all time you know we you kind of got to step back and remember like some of these things would literally be considered miraculous a century ago still are and still are it's amazing you know it's interesting you say that cuz just this week uh or just today this morning I was taking out I did a a case on a lady and we had to take out four implants they were just in the wrong place and we don't like to we like to use our our brand of implants specifically because I know and I can trust them and once you start mixing parts and pieces it can get real kind of sloppy and ugly the tire metaphor I always loved yeah true tell the viewers tell the listeners um well so when you're when you're mixing and matching the the the implants there's a lot of different parts and pieces and so it's a lot like if you went into your went in to get your car yes and they said "Well you know we don't have the the Goodyear in stock we have Firestone uh and it doesn't it's not quite the right size but it will fit your rim you know by the time you leave by the time you leave the place you're going to be riding sideways and put extra wear on on other things." And you know to your point like there's a lot of simple things that you can just kind of logically apply to this procedure it's nuts and bolts it's mechanics it's engineering right that really do apply right so I was taking these implants out today um and I was judging them i just was thinking of this as you were saying that about um thinking about where we came from i was judging them because they're not made for what they were put in for and um I was just kind of scoffing at them and like look at these goofy implants well those implants were made 40 years ago 30 30 years ago could have been the peak of Yeah that was the height of the of the thing so the reason why those are in there are or the reason why we have our procedure is because somebody did enough of those that they figured something out that made it better so I guess that's that's that's a good point you can't can't judge a implant by its threads sure there you go clip that one yeah exactly so um yeah that's just kind of the rundown of of uh kind of where we are and why why we think it's the greatest procedure and and a little bit of of where we came from but I appreciate you coming in ODM and talking to me about it and absolutely we'll continue to explore all these topics as we go along week by week day by day absolutely um again like we said last time um if we've got any any questions we want to make this very collecting questions as we speak so hopefully next episode we'll have a you know Q&A session yes sir we'll have a little Q&A session from from patient uh or you know not patients yet but just people that are curious people submitting questions so there's a lot of questions out there i I always say like dentistry and it's and it's totally understandable but it's a complete mystery to the average person and I say that as an average person who knew nothing about dentistry and I thought it was just me like I didn't pay attention in that class or something maybe I didn't go to the dentist enough but I think it's way more prevalent than that most people have no idea what their dentist is doing for them and you know some dentists are very you know they explain things and they want you you're very good at that you want people to know kind of how things are going to go and and I feel like you like to teach somebody that likes to learn but there's some dentists that are like they you don't need to know all that well I like I like people to understand what we're doing before we do it right right if we're moving a couch and we have to go through a a doorway I don't want to just jump in and have the other person not understand which direction we're going to go sure so the teaching that's how you tear your your bicep right there is is exactly like that you want you want that person you want your audience to know what you're doing and where you're going to go and why you're moving the couch in general right and that's where the teaching comes from it's not like I just want to like shove information down people's throat but I think I think the like not understanding or the public not knowing i think what will be cool about this is it'll be very conversational right i'm I'm hat and hat and long sleeve t-shirt today that's intentional because I want this to be relaxed i want I don't want to go off of a script of in 1972 we may do that occasionally but I don't want it to feel that way i want it to be very conversational and very like imparting information because I think there's there's there's sort of two sides to it that make it sort of uh obscure in terms of the the public knowledge i think part of it is attentional and we'll get into that cuz I'm going to blast some people not people specifically but the the industry a little bit right uh but it's also like I don't think patients I think patients just think it's gross and they kind of just shy away from it a little bit and maybe it's a little bit too complex for something or they think it's going to be too complex and so we want it to feel comfortable and we want our industry to start kind of opening up and sharing that information right we don't need to keep it under lock and key it's true not that it's not that crazy we're there are you know different types of patients you're going to get your one patient that's I don't care what you're doing i want it done i don't need to know the details but you're going to get a lot of patients that have anxiety and I think knowing exactly how something is going to go is relieving is comforting to a lot of people with high anxiety and just um I don't know you know it's always scary going into something when you have no idea how it's going to go so I think just this this trend and I always say social media's got a lot to do with it but like people are educating theelves and I feel like they're walking in and sitting in the chair more comfortable because they know more about what's going to happen that's my take absolutely absolutely and that's that's the whole point of this right yes us opening up we've always tried to be transparent we've always tried to be conversational we've always tried to keep like make sure that the procedure goes smooth and easy on my side on your side on their side uh cuz that just makes everyone's life better and so um that'll be this will be a really fun podcast like really fun like deep dive into this sort of like less formal very informational just kind of chill chill approach to it so I agree we appreciate you listening like subscribe download send to friends follow us uh we have a Facebook group that's very popular i think we're coming up on maybe a couple thousand people or something but a large majority of those people are patients who have been through the process so we always recommend you know if you're curious join our Facebook group also very open and uncensored we do not mess with anything there it is an open forum for discussion the good the bad the ugly um so we always highly encourage people if you have questions or you know just kind of want to get insight from the people who have been there join our Facebook group it's called Dunin1 Dental Implant Group uh that's that's a that's a good one um we're on all socials visit our website what is the what is the where if if a person's listening and they're not in the Facebook group or whatnot um where should they email how do they get a question to us yeah you can email us anytime at smilegetdonein1.com um and to be honest with you pick up your phone and give us a call yeah 561-4688812 and we'll get you to the right place if if you have a a question you think you know we might be able to answer right off the rip just give us a call we'll we'll talk it out um if you have a list of questions that maybe you're not comfortable speaking with a you know patient care coordinator email them to us um join our Facebook group ask there um come on our website fill out a form just I want to say our website is very informative we have tried to answer every question we've ever heard on our website so that's a really good place to start but you can't fit every single question everyone's ever gonna have on a website so we there's going to be more questions we encourage them we want you to reach out we want to answer them we want you to feel comfortable as you're researching and looking into this so again call email text if you want to any way that you're most comfortable with reach out to us and and we're here to get you the answers you need to feel comfortable awesome well thanks Robert thanks for having me we'll have you another time sounds good maybe we'll do another one after this we'll see but uh appreciate you guys listening and uh we'll see you soon thank you [Music]