The Fixed Podcast
Welcome to the The FIXED Podcast, your ultimate source for everything related to implant dentistry! Whether you're a dental professional looking to stay at the forefront of the industry, a student aspiring to specialize in implants, or a patient curious about advanced dental solutions, this podcast is for you.
Join us as we bring together leading experts, innovative practitioners, and passionate educators to discuss the latest trends, technologies, and techniques in the world of All-On-X dental implants. Each episode dives deep into various aspects of implant dentistry, from cutting-edge surgical procedures to patient care strategies, ensuring you get a comprehensive understanding of this revolutionary field.
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Whether you're looking to expand your professional knowledge, learn about the latest industry developments, or simply explore the fascinating world of implant dentistry, the The FIXED Podcast is your go-to resource. Tune in and join the conversation as we uncover the future of dental implants, one episode at a time.
The Fixed Podcast
Unveiling Three on Six: A Revolutionary Approach to Implant Prosthetics with Dr. Logan Locke: Part 2
As we navigate the landscape of full-arch dental implants, we examine the nuances of occlusal schemes in both three-on-six and all-on-six approaches. Dr. Locke offers insights from the recent ICOI meeting, sparking a conversation about the exciting potential of FP1 approaches in situations usually reserved for FP3 solutions. We highlight the importance of canine guidance and solid posterior contacts for achieving ideal occlusal results. Plus, our discussion emphasizes the need for practitioners to refine their skills in GBR and tissue grafting to tackle complex cases while maintaining aesthetics and functionality.
In our final segment, we tackle the transition from FP3 to FP1 prosthetics, exploring the benefits and challenges involved. Dr. Locke delves into the durability of zirconia implants and the hygiene advantages of FP1 prosthetics. With a focus on advancing the three-on-six approach, we discuss the potential for this method to revolutionize full-arch restorations and call for innovation from implant companies to support its mainstream adoption. Join us as we champion the democratization of these cutting-edge techniques, ensuring more providers can offer them to patients seeking lasting, comfortable solutions.
My name is Dr Tyler Tolbert and I'm Dr Soren Poppe, and you're listening to the Fix Podcast, your source for all things implant dentistry. My name is Dr Tyler Tolbert and I'm Dr.
Speaker 2:Soren Poppe and you're listening to.
Speaker 1:The Fix Podcast, we were talking with Dr Logan Locke all about three on six, and we're just continuing that conversation this week, getting into the nuts and bolts exactly what is necessary, the skills and armamentarium needed to do cases like this, and how you two can become a provider. Hope you guys enjoy. Yeah, that's great. That's great. So in terms of so I'm kind of going back to the surgical approach and things. So a lot of these patients are still very dentate. They still have most of their teeth. I'm assuming that there's a tooth born guide that's going to maybe locate some pins that you can put in.
Speaker 1:Then you're doing the atriomatic extraction, and then there's a pin-retained or bone-retained guide that then will fully guide the sixth placement as well, and then is there anything else on top. I mean, that's just kind of a traditional fully guided approach, right. Or is there any other nuance there?
Speaker 3:No, that's essentially what we're doing. We try and have everything tooth-borne. If we can Try and stay away from tissue-supported guides. Occasionally we have to hop on one of those. We'll have guides that help pin placement before we extract and then the same pins go into the spots after we extract. Anything that we can do to get a stable guide is really necessary. All of the abutment placement is all pre-planned so that we know we're not coming out of an embrasure.
Speaker 3:Yeah, obviously, the wax up. Everything is done prior to the patient stepping in the chair so that we can immediately convert and and screw in that prosthetic while they're asleep. So they're waking up with their, their single piece cross arch, cross arch stability. You know we're getting all that uh right off the bat, but it is a it's a thinner prosthetic and so we we really have to drive home the soft food diet, making sure they're not chomping on it, because that's something that can can fracture. But materials are getting really awesome there. You know, the more and more we dive into this, the better the results we're getting because of the materials and the technology that's coming out.
Speaker 1:Yeah, I'm curious too. So it kind of sounds like the initial surgical phase is almost indistinguishable from the typical FP1 that you know people see around where you know it's guided and usually there's like a scalloping guide for you know doing some bone reduction but plasty I guess just just shaping things. Yeah, do you guys do some of that sometimes? Or like, what's really the difference between, like a traditional full arch fp1 and a surgical three on six, if that question makes sense?
Speaker 3:really there's. There should be no difference. Initially, the main thing is using a lab that basically, this is all they do, and so they. We have trained our lab technicians and their designs to create pontic sites how we have found they work best, and because that initial prosthetic we have found is the key to everything developing thereafter. If you don't get an immediate prosthetic on, if you cover your implants and come in three months, it's all gone. You're losing it. And so that in order to maintain or create that architecture, yeah, we can do bone scalping guides.
Speaker 3:I like to think of my prosthetic as kind of a negative bone reduction guide, so I don't generally use a scalloping guide, even in super gummy patients. Basically, what we'll do is that the implants are already planned at the depth they're supposed to be. So let's say we have a really gummy smile. We know we're going to remove three or four millimeters of bone. To get away from that, we'll plan the implants at depth. I'll put my MUAs on, I'll scan without having removed any bone and then I will use the prosthetic which is then designed with my wax up so they know exactly how long my teeth should be. They know where the pontic sites should be. They're not referencing really the tissue data at all. Oh, okay, and then I'm going to, as I see that prosthetic and get it to um to engage with the MUAs. I know where I need to remove bone in order to create those pontic sites. So the uh, the initial prosthetic we use as a kind of a negative bone reduction guide in that case.
Speaker 1:Wow, okay, okay. So from what I picked up there cause earlier I was wondering about, you know, we mentioned getting the uh prosthetics to be some distance from the bone which is being left exposed to grow in that KG and I'm like, well, how are you able to scan this, cause you know, in our workflows we're always scanning soft tissue after. How are you able to scan tissue versus bone and plan this prosthetic? But that's not even a thing, because it's already pre-planned.
Speaker 3:It's pre-planned. So you know we have to deal with zenith points and how tall are your centrals compared to your laterals and your canines? Are you getting them at the proper depth or the MUAs Getting them to where? When I initially started doing these cases, almost always my laterals were longer than my centrals, just because that's where I was placing my implants and I wasn't thinking through these things through the design.
Speaker 3:So now that we have a lab trained, they can create, basically, and you're, you're using photogrammetry, you're, you're scanning, but it's a bloody field, we're not suturing before we scan anything. So, um, they're going to kind of blindly create these pontic sites. And now you're, you're generally guiding them through this design as they uh, they call us during the surgery once they've got the uh, the design transferred. And, uh, before we print it and we can make any sort of adjustments we want, um, if we know there's a piece of bone that's really high and we don't want to take it down and they've got the pontics too deep, you know, all that kind of stuff can be, can be changed during the surgery. But for the most part they're designing these cases in a way that aesthetically looks the best and so really, our bone reduction comes down to. What does that prosthetic require in order to get that ideal spacing?
Speaker 3:that ideal tooth shape and size.
Speaker 1:Yeah, no, that makes sense. So it's like aesthetics first, then prosthetics, and then eventually we're getting to plan the implant. It's like the last thing that comes in the conversation.
Speaker 3:Okay.
Speaker 1:Okay, yeah, no, I mean, that's, that's a beautiful workflow. I can really appreciate where that's coming from. That's awesome. You want to?
Speaker 3:mention this but I just wanted to clarify are are you guys, when you're using your guides, are you doing tooth toothborne guides? Are you keeping a couple teeth? Okay, yeah, we, we generally try and do everything toothborne and um. Really those teeth become our um when we take all of our scans, that those teeth we leave during the whole scanning phase uh, so that they can merge the files from the from pre-surgery to post post implant placement.
Speaker 2:Do you have a preference on which? What teeth you're typically so like? Let's say a patient comes in right and like your perfect case. I'm just curious what it would look like as far as what teeth are you leaving, what teeth are you removing? And then what you've mentioned a couple of times, but what teeth are you placing those implants into? Uh to get kind of that initial um stability and then a good support for the the truth born guide yeah.
Speaker 3:So I would say, uh, the majority of cases we are leaving. So implant positioning for us usually goes first molar slash, second premolar, where we're angling with the sinus Canines, laterals. That's generally our positioning for our implants. So that usually leaves some form of centrals that we can leave for the guide and usually we can leave a premolar on each side. We try and get three points of stability, not only for the guide but also for merging scans. Three points of stability not only for the guide but also for merging scans. Um, so, honestly, my uh, our designers know I will do whatever it takes to leave even a portion of a tooth in place. Uh, for the surgery because our scans.
Speaker 3:I don't like to place, um, you know, screws to align scans. I like to avoid those things if I can and all possible, and I like a really stable guide. So I'll cut a tooth in half and leave half the tooth for um placement of the of the guides and um for future scanning. I'll do whatever I can to to have that stability because it means so much um when you're dealing with, you know, half a millimeter for an embrasure space.
Speaker 1:Yeah, oh. So in other words, the some of the teeth could actually would have to remain somewhat intact in order for the guide to stay seated while you're placing the implants. Is that correct?
Speaker 3:Yeah, yeah, I'll leave as many teeth in as I can during surgery, cause that's what the guy that's going to be seated on, and then I will place, I'll put all of my MUAs on Um. Well, I use um micron mapper for the most part. Now we have an. I can as well Um, but I'll place my scan bodies, we'll do our scans with those teeth still in Um and then once I've got, you know, we try and we try and teach bottlenecks in surgery. This is a long, it's a long surgery, no matter what how you do it. Yeah, and so I'll leave all those, the rest of the upper extractions, till the very end, after I've got my lower printing, and so we can get that big. Our biggest bottleneck, I should say, during the surgery is getting those scans into our lab so they can then get them back to us to print. So once that lowers printing, then we're finishing up, we're doing our, our final extractions, we're grafting or anything else that we need to at that point.
Speaker 1:So is that to say that the approach is usually low, lowers first and then upper?
Speaker 3:No, I don't. We have one of our providers that does, just because he hates tongue swelling up over the course of four or five hours.
Speaker 2:So we have.
Speaker 3:Dr Weisenberg, who's here with us. He does his lowers first. For the most part I'm just a creature of habit and we used to do all of these when we initially started doing them. We were free handing them, we were doing some entertained and so you know I was relying on I would mark up their face before they went to sleep. I'm trying to use a fox plane and put my allotragus and I'm trying to keep all these things because then I have a pre-made prosthetic and I have to try and use my implant placement and get that prosthetic in the correct position.
Speaker 3:Cement retained during surgery was really really hard. Um, cement retained during surgery was really really hard, but it it honestly it makes it makes for a good surgeon because you learn how to, how to do all that stuff in the beginning. So, um, so yeah, now with everything pre-planned and you're you know, we can remove a lot of that difficulty from the providers. We can remove a lot of that necessary skills, I guess, because the lab is just can, can take all that information and they can put it into the prosthetic without you telling them to.
Speaker 1:Yeah, that makes sense. And what kind of um I think you mentioned when you first started, you guys were using high-tech implants and then you would switch eventually to neodymium CM. Is there like a particular system you guys recommend for this. What kind of nuances make it ideal?
Speaker 3:Yeah, so we had, uh, we were using neoden CM. I won't speak on neoden CM because I I have PTSD from neoden CM.
Speaker 3:You're not the only one Um so they uh, when we started seeing complications from that, um, we had a. We had a really well-known prosthodontist that was with us at kind of the beginnings when we were trying to make this trainable Dr Child. He's an awesome prosthodontist, we love having him, and he basically came on. He had a really good relationship with BioHorizons. He liked having having multiple platforms. So we said, great, we're gonna, we're gonna switch over. So currently we're using biohorizons for all of our cases. Um, we just switched to their new conical, deep conical. We do see, you know, that's one of the things I loved about neodent those suckers can hold bone really, really well. We like the internal connection, um, of course. But so the new biohorizons Deep Conical has been good for us so far and that's what we're currently using.
Speaker 1:Mad Fientist. And why do you guys like being able to use different platforms? Because in general like at least in the FP3 world like people want a universal platform, it keeps their stock a lot easier. They're getting switch and swap. So what do you like about having different?
Speaker 3:ones bashing neoda, because I think, of course, I think gm is a great implant and, uh, I think it's very similar to what we now use with with biohorizons. But, um, we were having those stupid cm abutments were fracturing, and so really we we wanted a wider platform for molar areas because we were worried about the, the strength of that platform, um, so now that you know there's a lot of time behind GM, now with this deep conical, with bio horizons, I think the, I think the data is out there to support that it's. You know, we're okay using those thinner, thinner platforms. Bio horizons does have have two with their new deep conical versus GM's one. So I I can get a little bit of a wider platform in the posterior, which I prefer, um, but we, you know it's that's kind of where that, that what drove us to a multi-platform, was just seeing fractures in in abundance in a CM.
Speaker 1:Got it, got it, and so, in terms of, you know, always keep coming back to prosthetics, of course. So, in terms of occlusal schemes, is there any way that people should be thinking about all excuse me three on six versus an all on six in terms of what you're looking to do occlusally?
Speaker 3:the most part what we train. We do train. We try and get canine guidance in all of our cases. Uh, solid posterior contacts. If if we're talking about, you know, bite paper, I want it lightly dragging in the anterior so we keep that too much pressure off of the vertices in the anterior, but just a solid, occlusal, spread out contact in the posterior. Canine guidance.
Speaker 1:Okay, and then I'm curious too about what are some of the big contraindications for doing a three on six. Let's say you have, like some really severe class correction or something like that. Fp3 gives a whole lot of flexibility with regards to trying to correct a bite or jump a class three or something like that. Are you still able to accomplish that with three on six or?
Speaker 3:does that?
Speaker 1:kind of swing you a different way.
Speaker 3:No, generally. Generally we can correct most of those things. Um, as far as contraindications, our biggest one is just you know that they've already got severe bone loss.
Speaker 3:They've been at dentures for 10 to 20 years. Then it's. It becomes a little bit more complicated for most patients. We still do a lot of um denture. We take a lot of denture patients into an fp1. But um, yeah, most of the time they if, if they've got really solid tissue um and really good bone underneath, we can still do an fp1 on it. But um, that's our biggest contraindication. It's just bone loss to the point where now we've got we can't fit six implants in or it becomes too much to try and segment the thing.
Speaker 3:So, otherwise, for the most part we're trying to get them in an FP1, if we can.
Speaker 2:On those patients that are denture to FP1, are you guys free handing those ones? Are you kind of like?
Speaker 3:We'll do a tissue-borne guide. We'll do a tissue-borne guide. I always when I train those, I tell all of our licensees to be cautious with it. Yeah, so I train a couple techniques of how to use them to hopefully have them become as accurate as possible, but for me I like to use them kind of as a pilot drill and then I'll usually freehand after that.
Speaker 1:Okay, yeah, that makes sense. And how does the ponic shaping go when you're dealing with a fully edentulous case Like? How do you end up getting all that scalloping and forming those pseudopapillae?
Speaker 3:Yeah, so the main thing you're going to, we take a lot of the tissue from the palate and we're going to transfer it all to the buckle of the prosthetic. That's going to help us develop the good tissue there on the buckle. As far as the bone, like I said, I don't generally do a scalping guide. I will use, if needed, the the prosthetic as a negative bone reduction guide. If I need to create some, usually it's like eight and nine. I need to be longer than seven to ten. So I'll usually try and create a little bit of, a little bit of a pocket for eight and nine to sit into so that we get the correct Zenith points, because it does look funky if you've got seven to ten, looking longer than eight and nine, if they're smiling really big, so that's something.
Speaker 3:But honestly, you could uh, you could do the case without removing the bone, and the prosthetic would just probably seat right against the bone on on eight and nine and that's going to cause some resorption, just in that you're going to get of itself, it's going to remodel and, uh, it's going to create the pontic site on its own wow, wow, no, that's that's great.
Speaker 1:That's great, yeah, I mean I'm so. I mean we just got back from the ICOI meeting in Orlando and FP1 was like a really big conversation going on there and that's a whole nother conversation for a different day about you know the ICOI and what they teach versus what you will mostly see domestically and things like that. But that you know the ISOI and what they teach versus what you will mostly see domestically and things like that. Um, but that was one thing that that really did amaze me is so many cases. I looked at him I was like, well, they have to do that FP3, um, because there just wasn't enough tooth. Um, it wasn't enough, uh, you know architecture to create that tissue born uh, sorry, not tissue born, but create all that. Really impressed. And and uh, there were just cases that I would you kind of said that allude to this earlier there are cases that I, with my FP3 trained eyes, would never think that you could approach from an FD1 perspective. But you know there are ways if you want to endeavor to do that.
Speaker 3:Yeah, there's, there's ways for. For most patients, I would say it's. You know it's not everyone, it's not indicated for everyone, but there's a lot you can do to make these things look and and uh and feel really, really good and it's. It's a fun procedure to do. It's it's complicated, which I like. I like doing these hard little things and uh, so it's something I find a lot of joy in and uh, yeah there's. It kind of requires a little bit of everything. It requires I. I tell guys all the time you know, go do your your GBR courses, go do your tissue grafting courses. You got to get this stuff in because you're going to use it all. You just you kind of have to in order to do FP1.
Speaker 1:Yeah, and, and I forgot to ask you, so the uh, when you're talking about moving palatal tissue over to the buckle, is that usually like a VIP graft, like the vascularized interpositional pedicle, or is it like you're taking the whole thing full thickness?
Speaker 3:I'll take the whole thing over, okay, no, I'm going to take the whole thing over. I'm going to leave it bare underneath the prosthetic and bunch up the KG on the facial of the prosthetic and just let it fill in.
Speaker 2:Very nice. Yeah, I used to see. It's similar to what we do with. We'll do the same thing Use a tissue punch to punch our multi-units in and then pull the hole in front of the tissue.
Speaker 3:I think that's essentially kind of what you're doing right. Very similar to that. Yeah, when I was taking my FP3 courses years ago, I remember seeing pictures of this guy. I can't remember what his name was, but he would essentially do these FP3s and he would just leave the lower completely flapped, one suture or anything, and he was like look at all this awesome tissue I'm getting. It sounded painful, like crazy.
Speaker 3:Yeah, I know Danny does that a little bit like yeah, crazy. But I mean, you're essentially doing something like that to a lesser degree. Um, cause we still suture and tissue glue or whatever we want to do to keep that prosthetic, uh, the tissue up against the prosthetic, but, um, you know, allowing that secondary intention for that, that tissue to creep in and and get underneath the prosthetic it, it can create some really good thick tissue.
Speaker 1:Yeah, and I'm curious too, like following the surgery itself. You know, typically at least, I mean, everyone's a little bit different in how they like to do it, but in the FP3 world people will have the procedure, maybe see the patient back the next day, some will do one week and then there's usually like a three week check to see how the soft tissue is doing, maybe they move to a water pick or something like that, that waiting 10 to 12 weeks and then taking new records and making new fp3.
Speaker 1:How does that restorative process and sort of the post-operative process differ um? For a three on six, if it does.
Speaker 3:Yeah, I mean it's. It's fairly similar. So we, uh, for the most part we're seeing our patients 24 hours after surgery um, basically just to dial in the bite any aesthetic issues, and then we generally don't see them again for three months. So we, at that point they call us if they need us but, like I said, most of our patients travel in from out of the country, so it's see them 24 hours after they hop on a plane, they fly back to their homes and we see them in three months where we will redo our scans, take our tissue data and tighten up anything that we need to make all of our aesthetic adjustments. We make them a second set of temporaries and we can do second temps and finals here at this office because we are close to the lab. We can have that done within seven days, but today. Otherwise, if they're close, we try and I try and have them stay in their second temps for a couple weeks to try them out yeah, so they basically are flying in three times.
Speaker 2:Is that correct?
Speaker 3:twice well sometimes three times yeah, a lot of times people, guys, uh, people bring their families out for their week-long appointment. They'll they'll make a vacation, they'll come ski and they'll you know, they'll visit utah and make it fun and uh, so we can see their, their finals within that same uh visit. Otherwise they get their second temps, they home, they fly back in whenever we decide they're they're ready to go with their finals.
Speaker 1:Okay, okay, that makes sense, and I'm curious too and maybe we haven't been doing this long enough for you to see this but have you ever had a patient that received a three on six and, due to whatever circumstances, then had to change to an all an X and, if so, what's kind of been their feedback about what they think in terms of how everything feels and the maintenance of it? Like, what's been kind of the feedback we've seen?
Speaker 3:I haven't had to transition anyone yet to an all-on-X.
Speaker 3:That's good. Yeah, you know most of our. I'm trying to think if there's anyone that has come through that's even close to that. Yet I don't think so. I mean, honestly, it's a little bit of an exposed abutment is about as bad as we're seeing currently. Um, obviously you're going to have some, you can get some implant failures and stuff, but we can work around them. So I haven't had to transition anyone yet. I did just transition.
Speaker 3:Someone went down to Cancun um, got an fp3. Actually it was fairly well done. I actually don't. They didn't remove enough bone, in my opinion, for the fp3, which worked in my favor. He came back, he hated it, um, and so within three weeks we transitioned him to it from an fp3 to an fp1. That's um, that was last month, I believe. Uh, cool guy. But um, yeah, yeah, yeah, that's. I haven't had to transition anyone yet. But I, I assume at some point we, we probably will. I mean, yeah, I think 20 years from now, we might, we might be saying something different and uh, and we're, we're ready to do that if need be. But I think we've bought these patients a lot of time.
Speaker 1:Yeah, and are you able to do a decent amount of lower three on sixes, or is this almost mostly uppers? Or if you are doing lowers, what are some of the nuances there that make that possible, cause I know that can be challenging.
Speaker 3:Yeah, we're still doing it. We do a lot um, equally as much on the lower um, because a lot of times that the teeth are shorter, you generally need a larger prosthetic space. You generally need more bone reduction in order to get a thicker prosthetic. For us I can have six millimeters of restorative space and I'm good, I'm not seeing fractures. Honestly, our fracture rate with these zirconia implants is close to zero. Like, if you segment and you're getting you know three to four unit bridges, they net the zirconia does not break it's, it's really really strong. Now, if you're getting longer span bridges then, yeah, you can see some fracture over time. But, um, even on the lower, with minimal, minimal restorative space, uh, where we've got really strong prosthetics.
Speaker 1:So it seems like there's kind of an inverse mentality. So, like when you first do the surgery, we're more concerned about the cross arch stability and making sure the implants integrate, so we need everything to be connected. But once those are healed and we go to the prosthetic phase, everything changes. Now we want them all segmented and that's going to be better support for the actual zirconia prosthesis long term yeah, yeah, better support for the prosthetic.
Speaker 3:Um, easier to clean? I mean they can floss in between the bridges. That's one of the main things we talk about is how you know if we're talking about hygiene. We've done a lot of measurements just on our own FP3s versus our standard three on six. Versus our standard three on six. You're taking the position, basically the area that's going to build up food and debris. You're taking that from an FP3, which is fairly hidden up there, harder for them to access, and you're bringing it down to the tissue level. So generally, they can see if they've got crap piled up on their teeth, they're going to be able to see it. Crap piled up on their teeth, they're going to be able to see it.
Speaker 3:Um, your your prosthetic to tissue contacts. If we're looking at thickness of how much space can gather stuff, so let's say, in an FP three, your average is cause as we. You know, as you go down, our bone is a triangle. So as we go down on that triangle we're getting wider and wider area to pack stuff. You know, and that prosthetic on an FP3 can be fairly thick. Ours we're getting small pontic sites, so the area where they can pack food and debris is much smaller, it's more visible. They can floss in between bridges, they can floss under them Super easy. Water pickiene on these things is just night and day over what we've seen in our own FP3 cases. I mean, we don't remove them once a year.
Speaker 3:We want to you know there's whether or not the research is good, that the tissue can adapt and adhere to the zirconia. We don't want to, most of the time, mess with any of that, any of our papilla that we've developed over years. We we want to leave it in there in place, and so we don't remove our prosthetics. They're easy to clean with just a regular cleaning. Our hygienists have no issue doing that, and you know you're.
Speaker 3:We're getting a lot less underneath these bridges than even our own FP3 cases which we feel like we do a good job with our fp3s.
Speaker 1:But you know, suckers are hard to clean yeah, I love those posts when, uh, you take off like an fp1 or single crown or whatever and it's got that ultra polished uh zirconia and they're, they're taking it off and it just takes tissue with it because it literally just actually formed a biological seal, which is crazy. Um. But uh, also I'm curious too. So, uh, the screws that you guys are using to retain these, um, is it just like the typical, like I mean like a desk screw, or are we using like powerball vortex, whatever?
Speaker 3:we have some guys using vortex. We use desks almost exclusively right now. Um, really, our long-term goal, everything is made for fp3. Currently, it's all yeah multi-units.
Speaker 3:Everything is fp3 and um I. There is a lot that we could do with stuff that was created specifically for fp1. We would love, uh, to have a wider and a longer prosthetic screw that was actually designed for a direct-to-connection. Most of these screws are still designed for titanium copings, yeah, and the MUAs are designed for FP3, which has a ton of variance in angulation. We because we're going between two units or two implants, we don't have a ton of degrees of variation we could have a longer MUA. That would. That would allow a much more stable prosthetic over time. So you know, there are a lot of things that we're working on to hopefully advance FP1 and get those, those parts and those materials that I think would would benefit patients long term, because and I think we would benefit patients longterm because and I think we'll start to see we're seeing a lot more FP1 come around.
Speaker 3:When we first started doing this, I mean you had guys doing it, but they were kind of off in the distance and you won't hear about it. Now there's more FP1 courses. Since we, since we, started doing this, there's more talk of FP1. I think it's coming back around to where you'll see more and more guys doing it, which I think is good, um, but I think we need the implant companies to step up and start creating parts that that adapt with the technology of where it is today and give us stuff that we can we can use that, uh, that address some of the challenges with fp1 yeah, we definitely, like tyler was saying earlier, we definitely saw it a ton at the conference that we were at almost to the point of going the opposite direction with FP3 and recommending FP1 on a lot of cases.
Speaker 2:What would you know? I think this is something that our listeners always love to just hear from whoever we have on the podcast. But do you have any particular CE that you love? Maybe any recommendations for books, learning this material? A lot of our listeners are people who aren't doing Full Arch and they want to get into it right. So if you have a couple of good books, a couple of good courses, I know you guys obviously have a course, but it sounds like before somebody comes to your course, it's probably good to get a good idea of like doing full arch, doing surgery and stuff like that.
Speaker 3:Yeah, for sure, we, most of the the. I have a lot of dentists that reach out to me fresh out of school. I send most of them to implant pathway. It seems like they do a great job. As far as getting guys going, I love, no, I'm going to. I'm going to forget their names, but there are two guys that I I kind of just started following through Instagram Dr Matthew Fien and Israel. He's out of DC, dc Implants is his Instagram handle. They have a set of GBR courses and tissue grafting courses that they're the favorite courses I've ever done, really Tons of good experience, and I think they really catapulted me into doing more of this and feeling more confident that I could build bone and build tissue and do that kind of stuff. So, um, their courses, uh, I can't remember what their group is called, um, but try to add to the show notes.
Speaker 2:We'll figure it out and try to add it.
Speaker 3:Yeah, yeah, I'll look it up, but those guys are awesome and they're posting amazing cases on Instagram, a lot of single units and I try and look at what guys are doing for a single unit, you know, someone loses number eight and uh, israel, that dude man, he, he can make it look like they never lost a dang thing with the way he develops tissue and, uh, his implant placement, everything that he does looks so awesome.
Speaker 3:So I kind of I try and take what he's done and anything that we can do to incorporate that into our FD1, because we're essentially just trying to do that at a larger scale. Um, so these guys that are really, um, leading the field in, uh, implant dentistry and in tissue, uh, these are two periodontists and we try and incorporate that stuff into what we teach okay, great, yeah, we'll try to add those to the show notes and those.
Speaker 2:Those are excellent. Um, just talking about that, it kind of goes into a new fixation that I've been having. As far as you know, we do, like I said, a lot of all in four stuff and a lot of immediate load and I feel like that's. It's pretty straightforward once you kind of get that down.
Speaker 2:And now I'm trying to figure out I'm getting more into like just immediate loaded singles, immediate loaded bridges you know, really like trying to manipulate the tissue properly so we can do these cases with a predictable result and without having to put a patient in like a flipper for three months and then come back, have to like try to figure out how to get the tissue to stay where you want it. Um, and you know it's not always possible, right, because I feel like it's much harder to get uh good torque on your implants when you're just doing like one tooth or even a bridge, versus when you have a clean slate and you have multiple places to place them. But what are you guys doing in your office as far as, like, single implant goes and like, are you immediately loading those? Are you printing them onto a tie base? Like how are you guys doing that?
Speaker 3:yeah well, uh, we've done quite a few recently where I'll put an mua on and uh have our lab quickly design some form of tissue shape on a single, yeah, on a single nice, yeah, then eventually I'll take, I'll take the mua, because with the mua I can use photogrammetry, um, yeah and uh, which is a huge benefit, and I can, you know, have them create whatever I want from there. But, um, I've done, I've done as much as using the. I cut off the fingertip of the glove and stick the, or stick a, an uh, an old abutment that I had sterilized, stick that through and push some, some composite into, into and shape it myself to create tissue, tissue healers. I don't do in the anterior front four, I'll immediately load it without any issue, keeping it out of occlusion. Beyond that, I still don't immediately load uh, single units, um, yeah, are you.
Speaker 2:And the front four, I mean, yeah, I think the front four are the ones that are the most important that I'm kind of referencing, because those are the ones that patients don't want to be wearing a flipper for, and and usually the like I don't know, the flippers never look like amazing up there, cause you kind of have no yeah, so are you? Are you typically? Always?
Speaker 2:always doing so and that, and it's funny because I actually have a case coming up and I was thinking about doing just that, doing like I'm putting a multi-unit on and and trying to print a crown right to that multi-unit. Um, I did a case last week where it was uh, seven to ten. We did a direct to multi-unit bridge and it worked awesome. It looked so good after and I was really really you just did a third of a three on six.
Speaker 3:Dude, you're, you're in.
Speaker 1:Yeah, yeah, he's gonna be a licensee. You're already there. You might as well sign up now maybe well, but what?
Speaker 2:uh okay, oh, I just want to finish a thought, so um when you aren't doing printed to multi on those anteriors, how do you, how are you doing them? Are you doing printed to tie base? Are you are you kind of designing the crown yourself for those single anteriors?
Speaker 3:Oh, yeah, for the most part, I've done a lot where I will use their own natural tooth. If I'm just taking it out, which is generally the case, right, we're trying to keep and preserve everything I'll use just a regular use, uh, just a, a regular um. So, yeah, just a tie base or something like that, and I will cut everything but the facial off of the tooth and I'll, you know, create the shell and then I'll pick it up that way, take it off, unscrew it, shape it with, uh, with flowable or whatever I need to do, polish it up really, really good, and then, and then go with that. I know there's's, uh, israel Puterman, same guy, um, hopefully I didn't botch his name Um, that runs these courses, his, his Instagram.
Speaker 3:He's got, he's got some specific um, printable tissue healers that I think look pretty awesome, and I can't remember where he gets his from. But I've thought about starting to do kind of exactly what he's doing, because he gets some crazy results. But, yeah, I like, I like creating my own. That's generally what I've done just using whatever they've already had in there and create a shell and then get the, the correct form coming out of the implant so that it develops that, that that tissue, and we've got a lot of experience in in doing that, so that helps.
Speaker 1:Yeah, great, and I may have been yeah, I may have misunderstood you a moment ago. So when you're doing uh like that interior single and you mentioned um using photogrammetry, so you put the mua on there, then you put your uh micromapper scan body on there, you take your micromapper and then that's how you're printing out uh attempt. When you go to to finalize that, are you then using that data to swap to fixture level or do you just keep it all MUA?
Speaker 3:No, at that point you're getting rotation on the crown right.
Speaker 2:Right, okay.
Speaker 3:So it doesn't work for a permanent super well. If it's out of occlusion you can usually keep it from rotating or you can sometimes bond it to the teeth on either side or create something so it won't rotate.
Speaker 3:But I generally would just do that for an initial tissue healing type of situation okay, yeah, tissue former, then I'd put my scan body or my impression coping on, get a bunch of um light body in there so it captures what I've already created, and uh, and then get a screw retained crown with a custom put in cool, yeah, yeah.
Speaker 1:So we've talked a lot about you know what's kind of taking you from. You know pre three on six to now, and now I'm kind of curious about you know where do you see this being in? You know 10 years. What you mentioned a moment ago like long-term goals, like where do you kind of see this concept going? Where is the innovation going to be at? If you see any room for that?
Speaker 3:Yeah, I think the innovation will come, and we're pushing BioHorizons, we're pushing implant companies to help us create things that are more geared towards FP1. Like I said, there's so much technology right now. There's so much that we could be doing to make these cases easier and more predictable. We just need these guys to come along and make the parts for it. So hopefully, that's where the innovation comes. We are continuing to just make our processes streamlined as we possibly can. We want more guys doing it.
Speaker 3:We want patients to have options to preserve their bone long term. We think it's the correct thing to do, um, and so ideally we get as many doctors providing three on six as we possibly can. I think that's what our, our long-term goal is. Um, you know, obviously we want that financially, but it also like I would say% of patients that are going through full arch still have no idea that FP1 might be an option for them. They just don't know that it exists, and so it's only those that hop on Google and start to search for other options that really end up with us. So I think if once we can get to the point where patients are informed that there are options, then it's going to drive more and more doctors into learning how to provide FP1 for their, for their patients, and whether that's with us or doing it on their own, I think it's good for dentistry to have more doctors doing what we're doing.
Speaker 1:Yeah, no, I totally agree. I mean there was a time when, you know, people were just doing one implant per tooth and doing all kinds of crazy grafting and these hugely staged approaches over years and years and years, and then all an X or really just all in four at the time kind of save the day with that and nobody knew about it. And then, once people knew about it, there was this massive, massive wave. And now you know patients have general awareness around that and they go around shopping for the best prices or the best processes or whatever to get it done, and it seems like you're kind of.
Speaker 1:You know, in this early phase of that three on six, awareness is starting to happening, providers are starting to pop up in places, people are having more options and, you know, before you know it, this is going to be this. I mean, we may already be there, but this is becoming this really emergent thing and that's what patients are looking for, because they do want that conservatism. You know, especially if you're younger than you know, an fb3 is probably not going to die with you no, no, we, we know these things probably won't.
Speaker 3:We hope they do. We hope that what we do is is will last as long as possible, but I think, sure, of course, giving someone longevity and options as they move forward. Um, yeah, I think is is important and yeah, it's been. It's been kind of a weird process. Just uh, a week or two ago, these YouTube videos start popping up with three on six and why it's awful and it's a cult and it's really weird stuff and it's weird seeing something that has been so small and it's been something that we just kind of made here in Utah and a name that I mean.
Speaker 3:we didn't make, fp1, we just made this little three on six thing and now to start see it pop up on insurance forms and and on other doctors, youtube videos and it's. It's been a funny, funny thing to see happen in the last couple of years, but it's uh. I guess it means we're doing something right.
Speaker 1:Yeah, well, I mean, I think it's really cool and you know, I think we feel um particularly fortunate to be talking to uh, the pioneer of uh three on six, um on our podcast. So maybe, uh, you know, once it becomes this big popular thing and people are doing the research, they'll go and find our podcasts and and they'll get to learn about the beginnings.
Speaker 3:Hopefully some guys get interested and want to come out and hang out with us. I think it's fun. I think our course is awesome. We have a Teams chat with all of our providers and everyone's just posting cases and questions. I generally stay away from dental forums because I think dentists are jerks.
Speaker 2:Yeah, forums, because I think dentists are jerks.
Speaker 3:Um, yeah, just you know they have to nitpick every little thing that someone else does, um, so I tend to stay away from those, but, um, we've got a really good forum, awesome providers, awesome docs.
Speaker 3:That's been one of the most fun things for me. I'm not, I'm not, I'm not a super well-spoken person, so getting into this training role where we're teaching doctors how to do this, and traveling out and meeting their staff, it's been super fun to just meet a lot of like-minded doctors and get to know them and develop friendships with them and be able to have a guy down in Florida that's, in my mind, just an awesome FP3 provider. And so in places like you guys, he's doing teragoys and everything and I love having someone that I can run some stuff off of. And then I've got a guy that switched from just doing wisdom teeth in Vegas. He decided he was done with wisdom teeth and he just wanted to do FP1. So he's just a three six provider in Vegas and uh, so you know, being able to meet him and when I have whizzies I need to do I'm texting him. What the heck, what am I doing?
Speaker 2:Um, so it's it's.
Speaker 3:It's been a fun thing to to get to know doctors and and, uh, you know, be in a situation like this and meet you guys. It's fun for sure.
Speaker 2:Well, hey, we're honored as well. And what can people do? If they are interested in your course or they're interested in, you know, getting into the three-on-six, what's the best way that they can reach out to you? You said the other doctor was it Peyton, or what's the other doctor's name?
Speaker 3:Randy Roberts. Randy Roberts.
Speaker 2:Randy Roberts, I'm sorry.
Speaker 3:Michael Weisenberg. He helps me run the course. And then Randy Roberts. He's the one that started this whole thing and he's kind of leading our R&D and what we develop as far as progress moving forward.
Speaker 2:Cool, nice. So yeah, how would people reach out to? To kind of get involved, get get over to your course and start doing the three on six.
Speaker 3:Yeah, if you want to. So three on sixcom, our trainings should be on there. You're my Instagram. I try and post a lot of what I call tissue porn Just really good scalp tissue. I like to post that kind of stuff. Um, so if you want to see kind of what we're doing, uh, my Instagram is doc dot lock. Uh, that's L-O-C-K-E Um, and they can message me there, they can text me Um, my number's 8 0, 1, 7, 5, 5, 9, 2, 4, 3. And you're welcome to text me. I'm happy to send, to send you. I, whenever I talk to guys and they're questioning whether or not they want to come, I just go through my camera roll and find my most recent cases and shoot them over and say this is what you can do like, this is, this is what we're we're pushing out, and, uh, I think for the most part it helps them gain the confidence to come on out. So welcome to text me and I'll shoot over some cases so you can see what we're doing, and uh, or message me on Instagram. That's good too.
Speaker 1:Awesome, awesome, awesome. Well, we really appreciate you coming on, dr Locke. This was a huge learning experience for uh, dr Poppy and I and um, you know I'm really excited about what you're doing. I think you've made a massive contribution to the full arch world and you know we always talk about um. You know how to be conservative in an FB3 case right, like trying to preserve bone or do a more conservative uh technique here and there to keep people out of zygomatics.
Speaker 1:And um, you've you've created this whole new intermediary phase between that um, you know, the natural dentition to the FB1 and and then, of course, the FB2, fb3. And you know, I think the the beauty of it is is you know we're getting to the point where we can really support people throughout their entire life cycle and, you know, keep them in teeth they don't have to come in and out, you know, as long as possible, and I think that's a it's a really valuable thing. I love that you've really democratized what you're doing and made it very approachable for other providers. It'd be very's in the right place and uh, I just I feel so privileged that you came on our show.
Speaker 3:I appreciate it, guys. You guys are awesome. It's been fun to get to know you and uh yeah, hopefully, hopefully we get to do more of this.
Speaker 1:Yes, sir, you got it Well, until next time, thank you.
Speaker 3:All right, thanks guys.