Speaker 1: 0:40

My name is Dr Tyler Tolbert and I'm Dr Soren Poppy and you're listening to the Fixed Podcast, your source for all things.

Speaker 2: 0:47

Implant dentistry I'll tell you that whenever anybody mentions like hey, what's the first, what's the course that you'd recommend going to for implants, I mean we recommend it, but everybody recommends it. It's like, hey, pathway, pathway, you can get to fast track. Like that is the the place to go if you want to like start placing implants. So you guys have done such an excellent job with not only marketing yourself in that space but also creating that environment where, when people go, you know they have a good time, doesn't matter what their background was. They feel like they uh, you know, learn a lot from it and they don't feel judged by. I feel like you go to a lot of full arch courses and the first thing they ask is how many arches do you do currently, or how many implants do you place, and it turns into this hierarchy type of thing. But the reality is people are coming to Pathway because they probably don't have a ton of surgical experience. Or, if they do have a good amount of surgical experience, they're just looking for a good, solid basic education on placing implants because they want to provide that to their patients. They want to provide a solution that the patient doesn't need to get that bridge and, you know, prep two virgin teeth that probably will last for a really long time or whatever it is. But I feel like so many dentists, especially in rural environments, they just don't have anything like that near them. So it's really cool that you're able to to create that. And, um, you know, tyler went and he, he got all aboard implants and I know I kind of trailed on Tyler's tails and got into the implants as well. So I mean I'll I'll say that that probably is what got us initially into this space as well. So we, we really appreciate that and we have had, um, you know, we, I've been, I talked to Chris a lot, um, and I love Chris and I think he's a he's a great clinician, um, and he told me all about how he was in Denver here working under the doctor here, and then, you know, made his way to your office and really got to dive in, because I think when he was here he was doing a lot of restorations, a lot of like occlusal, like making sure everything Prost, yeah, a lot of prost stuff, and then he wanted to get into the surgical part.

Speaker 2: 3:03

So he found you there and I think that, um, that was a great opportunity for him and now he's. You know, we we talk about him on our podcast. He's like one of the guys I look up to for a lot of the remote anchorage stuff. Um, you know, like him holtz claw. A lot of those guys when you're when you're trying to fix someone who comes into your office who has maybe been through the ringer already and they've got zero bone left. Like those are the guys that that I look towards for for figuring out the solution to that case.

Speaker 1: 3:32

The last stop um.

Speaker 2: 3:33

So you're right. You know the people around you are what are what? Uh, you're the best for the people around you, and chris is great, and you know we had a opportunity to work with vorholt for a couple months too. He's been. He's been great to us and a very good clinician as well. So I think that you know you did a great job with establishing people in our industry that were looking for that next step in implant dentistry, and now we have such a great um, a great opportunity to learn implant dentistry at pathway, so we really appreciate that well, I, I appreciate that you know, but those things, um, you know, those things mean the world to me because, uh, like you know, I couldn't be, I couldn't be any more proud of you.

Speaker 3: 4:21

you know, like a Chris Barrett, like you, like I remember I remember him placing his very first implant in, uh, uh, you know, in in pathway because you know he came out of, uh, uh, a a high end cosmetic practice in Cherry Creek. Like, like, like, yeah, like she left a practice that hundreds of dentists would just be thrown into the mouth to be at that kind of high-end practice and it wasn't fulfilling to him and to see him not just take advantage, seeing Chris place his first implant to have a conversation about, like he's like, man, I think I'm gonna, I think I'm gonna go learn how to do like the zygos and terry's, and I'm just like like go go do it, tell me how it is, because, like I'm I'm not 100 sure I'm about interested in it. I said, but uh, in, like he came back and like it was like through another long fire, right, like it was getting him up, and like going in the day and he's the most level, he's the most even keeled human on the planet Like he's unrattled. You can't rattle him and you know I love those stories.

Speaker 3: 5:38

You know, and I think about the people that you know have, you know, just blossomed you know in that you know of. You know just blossomed you know in that you know, on the mentor side, uh, you know from, uh, josh mcgow, and, of course, uh, you know, uh, way, uh, way, you know, when it came in, um, and you know all the, you know all the people. And then there's, uh, I don't know if you guys, you, you guys, know who Tommy Graff is.

Speaker 1: 6:05

Yeah, yeah.

Speaker 3: 6:07

Yeah, so you know, one of the docs who took the course this week was referred, you know came because you know Tommy told him he should come. And I always tell people like I ruined Tommy harder and faster than anyone else on the planet because, like he took Pathway and then like like three months later he took uh, chris and raj's uh, uh all on x course. And then like three months after that he called me one day and he was just like he made me I get this crazy idea to run by you. And I was like, yeah, what's that? And he goes yeah, I think I'm gonna fire my hygienist and everyone in the office and turn my office into an implant only cell. I remember I'm gonna fire my hygienist and everyone in the office and turn my office into an implant only.

Speaker 1: 6:45

So I remember I remember when he did this and I was like tainted, oh shit.

Speaker 3: 6:51

But then I was like.

Speaker 3: 6:52

You know what I did the same thing, yeah, you know, like I left, you know it wasn't for an arc center, but it was for all implants, and I was just like you know, I left this, I left that private practice out because I didn't want to do it and I but I wanted to be happy, you know, and I wanted to do things that fulfilled me. And uh, look at him now he's got chase with him and like, like you know, and uh, all the, you know all the things and uh, and he's and you can see it in and suffered and I, you know, I, I can't, I can't mention them all because they're like they the list is long but like it's, it's what's, um, really, it's what makes me get up every day and love to go down to the center.

Speaker 3: 7:34

And uh, now we've got this big, beautiful facility and like all this other stuff from uh, but it's it, it has nothing. You, it's funny because people are like, oh my God, you got this like beautiful facility and all these 32 operatories and all these things. But you know, I'll tell them like it's only as good as the humans that walked in that door. You know that building doesn't do anything. The building and the equipment and stuff. They don't do anything for teaching and getting people to do things. Like it's all about the people that come there.

Speaker 1: 8:05

You know, I think something that impresses me the most about Pathway is, you know, as it's grown, it's remained and almost become more nimble over time in terms of as new techniques become more, you know, proliferated into the general consciousness like remote anchorage and things and new technologies, pathway has a course on it almost right away and you guys are able to offer so many different courses for whatever people, whatever experience level. People are coming in with what they're trying to get to and I think a lot of that speaks to the mentors that you guys have in your atmospheres. You know, as they continue to push boundaries, you know you guys are democratizing that into courses and bringing people into it and the, you know, obviously in a safe and controlled environment. And you know, a lot of times as organizations grow, it's even harder for them to innovate, it's harder for them to increase their offerings and create that for people, and you guys have managed to do that just wonderfully.

Speaker 3: 8:57

You know I appreciate that because I I find those courses. You know, like I told you, I even gave up the teaching, being the lead instructor for the sinus course. Andrew Prury, out of Atlanta, is teaching at Warino and I do that because, like the mentors that come and give of themselves, you know they're doing this on a day-to-day basis and you know I think about some of the recent courses that we've. You know that we've added to. You know, obviously, um, you know I. You know dan holds claw and his, uh, you know, remote anchorage, like yo today to we got he only does uh, um, he only does four docs at a time after the live surgery thing. It's a small lot and yesterday he did a demo quad zygote with an incisal canal. Today, I think, doc Leland did a quad zygote with some transnasals. It's crazy, but you know there's a call for that and you know I think that being nimble to, you know, create that next step is like it's okay to go out of country and do those cases and we know why people go out of country and do those cases and and and we know why people go out of country. But like, for me, like I think you can serve more people being here and we can serve the dentist better, because those those procedures like they gotta be taught to treat a plan and and and provide the care and the followup and stuff, and to the standards at which we would be held. It's got to be as close to your simulation of your own practices as possible and you're just not going to get that, I think, outside of the US. But I also think that that is one of the there's two courses that I think are the most important new additions to the course, and the one is the remote anchorage because, as Clear Choice and everyone out there has been, eating up arches and mowing down bone and creating FP3s and stuff.

Speaker 3: 11:21

As we've done this, there's a tsunami of complications coming. There's a tsunami of failed arches and this has nothing to do with bad dentistry. This has everything to do with time and I'll tell you, arches that were done 10 years ago are on implants that are nowhere near the technology that we have today, on techniques that had yet been refined. Yet we did them at a high level, and the issues that I have with that um is that the damn courts and people judge us today, yeah, by what we did 10 years ago and it's not right because the technology and the techniques and the and the and the reps have increased over this amount of time and you can't not solve for that right.

Speaker 3: 12:30

So there's a need for remote acreage because, as implant dentistry at full arches age and fail some of these people, that's the only place you're going to go. That's the only solution they have at that point is to be able to go to those. So that is one of the reasons. The other one that I'm really passionate about is the FP1 course that Josh and Wade are doing, because what you talk about just what we did is we need to really learn about these. You know how to deal with younger people that have bone and you know if you're getting this done in your 20s, 30s and 40s, like you're going to need a revision in the sick in in your 50s or 60s, and you know, without a doubt, like like you know, probably everybody, but like there's a good piece that are going to be there, and then what?

Speaker 3: 13:27

then? What happens when, when the revision needs to go, well, then the next step is, uh uh, remote, engage the. The next step is remote, engage. Yeah, you know, and this is this, this lies in line. But the but the, the fp1 is a is a is a stepping stone and a and a bow.

Speaker 2: 13:47

I call it a bone holder for those humans that don't need to have an arch mode down, and I, and I feel, I, I really I'm super passionate about like the that being treated the way you know, the way it is I got a couple uh comments on on what you said and and one of them the first one is talking about the courts and like how, how they're seeing cases that you know maybe were done 20 years ago when we didn't have the technology that we do now. And I get I get frustrated about this too, because you know my thought like kind of what what I compare it to is, but you, years ago, almost every and correct me if I'm wrong but a lot of patients that were going through ortho got all their premolars out and took out all the premolars the first pres and then did ortho, and now we don't need that anymore. But if they went back and ostracized every single orthodontist that did that then, because that's the technology they had at the time, you know there'd be so many orthodontists that be sitting in court because they were taking out virgin teeth that maybe didn't need to be taken out. And I would say the same thing.

Speaker 2: 14:57

You know at the time we didn't have photogrammetry, we didn't have all the solutions that we do now, but the dentists were just doing the best that they could with what they had and trying to please the patient, to give them a remote anchorage solution, and maybe they didn't know about root banking and socket shielding and FP1s and all this stuff that have come out in the last five years. Sure, um, there's. It probably would have been a better treatment option to give a 28 year old like a nice fp1 with all these solutions, but at the time that technology wasn't out and the only thing that they had was was an fp3 prosthetic and it was either that or a denture, and you know damn well that if they put them in a denture, there's either that or a denture, and that they do now getting them you know, and I hope that, as some of these you know, if, if more and more of these cases kind of come to court, that that becomes that.

Speaker 2: 16:51

People kind of mention that, because my opinion is putting somebody in a denture too, like you're. Just they're going to eat away bone over time. No different than putting in implants. Let it happen naturally or artificially, right exactly and you can't ostracize somebody for doing the best they could with the technology that they had at the time that those implants were placed um. So that's my opinion on that well, your opinion is not wrong.

Speaker 3: 17:19

Uh, and the you know that, the you. We live in a world where you can sue anyone for anything, which is like whatever you know. But we need to. And you know I was me and my generation were guilty of when for implants, like you know, literally 27 years ago when I started doing this, like nobody really believed in them there. You didn't have long track records, didn't have long studies on them. You know things like that. They were just starting to get you know kind of mainstream at the school.

Speaker 3: 17:53

No, school was teaching it when I was going through there and, um it, we contributed because we sold implants as like, hey, like there's no nerve, there's no need for root canals, you're not going to rot, the teeth aren't going to rot, you know, but we didn't. I mean, I remember, you know, when I left MISH, you know like I, I was placed in the BioRisin square threaded parallel wall external hex implant which, like, no, like, no one places today, but that was according to the literature and what we had, like that was the best implant that we had. Yeah, you know, in it, yeah, it loses bone down to the first dread, but the time it does stop, you know. But lately, like, we sold this as being a better than we sold it as a being a super treatment when it was just a treatment and, uh, you know it's better than the average, you know it's better than a bridge or a denture, but like, it's not forever and and we, we cycled through that and now we're seeing it on the back side.

Speaker 3: 18:56

These people, you know, they, you know they're paying 40, 50 000 for a new arch and they and they have a, they, they have some implant loss or they have a prosthetic loss and they're like mad, you know, and they think that this should have, you know, survived forever. And the reality is that, for one, I think dentistry, I think dentists, don't teach enough, don't take enough. That I don't. I don't think that we honor how a patient loses their teeth enough, and what I mean by that is like when they, when they come to you needing a full arch, they've already. They're already speaking to you in an unwritten language that they're not. They don't have a track record of keeping, of taking their teeth, whether it is their love for crystal bath or perio, which are two separate problems in themselves. One leaves you with bone and one leaves you with no bone.

Speaker 3: 19:59

But the reality of that is that it's different dentistry than single-tooth dentistry, because you can take great care of your teeth and break a tooth and have to have an implant and those of us that are in the arch world not all of these patients are going to be just because they can afford to fix them doesn't mean they're going to take care of them.

Speaker 3: 20:21

It doesn't mean they're going to do any of the things that we ask them to do. They're going to take care of it. It doesn't mean they're going to do any of the things that we ask them to do. And when we take that into consideration, we've got to understand that a certain population of those patients, we're going to have some bone loss, we're going to have perioplantitis and ultimately we're going to have radishes and things because they're just not going to do. And we also don't take into account enough, I think, that the uh, the, the patients, um, sometimes are not good hosts. You know, the older they get, the, the the worst we heal like like there's, there's, there's, there's lots of things there along the way.

Speaker 3: 20:56

So health issues, diabetics, you know, maybe, yeah, yeah, all the for sure you know like, uh, I like I tell this story and I don't mind. Like you know, we talk about health histories, you know, and you mentioned diabetes. Well, like it's fine, but like so many people in America don't even know they're diabetic and they don't check the box. You know, Like you can be what I think to look fairly healthy and be a raging diabetic and uh and and fool everybody because, you know, as dentists, like we, really, I mean I love the health history with all new answers. I mean it's a, you know, I don't have to think about it, right. But now I think more about that because I was like, okay, I'm going to correlate, like okay, this person's in their fifties. They put all no answers down. I'm guaranteeing, or I'm thinking about the patient. Maybe they've never even been to the physician, so their no answers are truthful to them, but not necessarily the reality. And I'm going to give you a case in point in that, in January of 23, when I went to the Mayo for my executive health that I go to every year, my hemolybin A1C was 9.7. But you know what, I got up and went to work every day and I didn't think I felt bad. And today, coming up on two years.

Speaker 3: 22:29

I've got a continuous glucose monitor on my arm and in January of 24, I had it down to 7.6. And then in July of 24, I was at 6.7. And then Monday was my three-month check and I'm at 6.7. And then Monday was my three month check and I'm at 6.6. That's great, and you know so. Uh, and I I say this because I didn't have any of the other symptoms Like I, you know, like I, I didn't get up in the middle of the night pee.

Speaker 3: 23:00

You know, like I, I I brushed my teeth every day so they weren't bleeding. You know, like made, I, I brushed my teeth every day so they weren't bleeding. You know, like, all these things right, but like I was, I was headed the wrong direction, you know. So, like you know, I lost 37 pounds and I did all this stuff. And, and my point of that is, it's like, like so many of our patients don't know, yeah, because they don't know. And it is so important to implant dentistry is to understand that because as we get into the arches, we're dealing with older people Like we're. Yeah, we get some of those young ones we were talking about FD1s and things but the vast majority of the patients that we we see. I don't know what do you guys think? They're over 50, probably right? Oh yeah, Yep, I would say, yeah, I would say.

Speaker 2: 23:41

You know we do arches in patients less than 50, but a majority of my patients, I would say, are 50 plus for sure and, and I agree, you know it just is part of our population, the population that's coming in that need all their teeth removed. Typically, the reason that they need all their teeth removed is because they haven't gone to the dentist probably as much. I mean, there's a lot of reasons, right, but one of the reasons is maybe they haven't gone to the dentist as much as they should have. So I think you're spot on in the fact that you know it's probably good to if they're not going to the dentist as much as they should have maybe they are. They also aren't going to their physician as much as they should have.

Speaker 2: 24:20

So when that patient comes back and they have a couple of failed implants, it's probably, you know, good to get a blood panel, make sure they go in and see their PCP and and um, ensure that they're healthy. And those are the reasons why you can probably figure out the reason those implants fail. Um, but it is, I mean, and I think that it's, it's difficult, right as a, as a provider too, because you have a patient that's coming in looking for a solution and they you know, maybe they're they've got a ton of infections going on and you want to provide that solution to them and the best one you can offer is something, something fixed. But if they go through the whole, their whole physician care, that it might be six months down the line before they can get that done. So it's tough, right, right, like it's like okay, do we fix the teeth first or do we fix you know, I that's actually.

Speaker 1: 25:08

it brings up something interesting. I was at a. I was at the ICOI. We were both at the ICOI recently and a doc that was a fan of the show had come up to me and he talked about how, on one of his patients, they had some undiagnosed condition and he'd done a full arch on them and all of them had failed.

Speaker 1: 25:24

And now he's like well, now I do a blood panel on all my patients. And I'm like that's great. And he was like are you not doing that? And I'm like well, no, I'm not, even though in theory that sounds like a great idea and I'm sure that over time I would reduce failures and things like that. I've got a lot of patients that if I tell them that they we got to make sure all this is going, they're, they're never coming back to me, you know. And and it's not just about keeping the business going, it's about, like, you know, this patient needs some sort of intervention and most of the time, um, you know that blood panel could come in handy, but most of the time these things do go well. So it's this question of like, do I want to take every single precaution possible to catch all of those things, um, is that going to now become a barrier to treatment for people? I really don't have a great answer for that, but it brings up an interesting question.

Speaker 3: 26:10

You know, I think I actually think the answer lies somewhere in between, and here's why I think that is. I think that I think what we could do, I agree with you, like you have every patient that walked in the door that needed a full arch and you said, hey, listen, you've got to get over to your PCP and get a physical exam and a blood panel and stuff. Yeah, we'll do far less of them. Would it make healthier candidates to have the data and stuff? Yes, for sure. But I think that there's things that we can do. I think there's things we could do and I think it's because I think it's how we become a better detective and I think it's like. I think it's like going through the health history and being more jock houston. Right, like like asking more questions about as we get through there. You know, this is like hey, like you know, tell me, you know, tell me about what last time it went to this issue. Oh, asking more questions about as we get through there, it's just like, hey, tell me about when. Last time it was a physician, I don't know how we have it now. Tell me about how you feel. Have you ever had your blood pressure checked? Because we just took it and it's a little bit high. I want to know if that's average or just nervous. Does your tear hurt?

Speaker 3: 27:24

Someone asked me how do you know if they're titanium out? They're sensitive to titanium, and I was like, oh, you know you can do the Melissa assay test and that it's the same thing. If I set every single person for an implant for Melissa test A, it's expensive and B, I'm going to lose most of those implants because they're not going to go. But what about deep diving for an implant for melissa test a, it's expensive and be able to lose most of those implants because you're not going to go? But what about? What about deep diving? Like, hey, you know, I was like they see that you had your knee and your hip replaced. Yeah, well, like how, how you know, how'd you heal right? Like, like, how'd that? How'd that go? Oh man, like we had no problems.

Speaker 3: 28:04

I was up on it and I said, well, how old are they? Well, they're five or six years old. You had any issues? No, no, like I have it. We can listen. You just got a small snapshot of the patient's got titanium sensitive? No way. But what if the patient says you know, I've had my hip rigged down a couple times. I'm probably going to have to have it down to my knee. Listen, that might be your clue, right? That's your breadcrumb. To wait a minute. They're not taking to this prosthesis. Well, they've had multiple problems, which is not uncommon. And if they have, who's to say it's not the middle? And all I'm saying is maybe that's worth the deep dive and maybe that's worth the assay test to do it.

Speaker 3: 29:01

So when we talk about a full count panel, maybe we do do that on the, on the, the, the human that is 50 plus, that's never been to the physician and has, you know, numerous lesions and things like that.

Speaker 3: 29:16

Like, maybe you know, and, and maybe that patient's think about this, maybe that patient I always tell people, man, I like to watch my patients a little bit in the waiting room and I like to watch them walk to their operatory, because it tells you a little bit about them. Right, like, can they hop right up and can they walk down the hallway? Or are they winded when they get there? Right, did it flush them? Right? Like, look at their arms, like, do their arms have bruises on them? And like, like, there's little things that we forget are clues to a patient's overall health that may lead us to that. You know what I think. This one like that, like before we spend fifty thousand dollars and and I I've done this and I preference it with you know Doc, or you know patient, mr Jones, have you bought a $50,000 car before? Well, today, I mean, that's actually kind of an average price.

Speaker 3: 30:20

Yeah so like if you bought a, tell me, like if you bought a fifty thousand dollar car, like you're gonna kick the tires and and and take it for a test drive and and you know, look around, and that you know. Um, mr jones, I did. I think we need to do the same thing with here because you know, before I and before we spent 50 grand, like, like, we need to do the same thing with here, because before we spent 50 grand, we need to put it up on the hoist and take a look at the drive tree and take a look at the tires and make sure that what you're paying for will get you down the road a ways. And I always like car analogies. The reason I like car analogies is everyone has one and the assumption of owning a car is that, yeah, you're going to need to change the oil and change the tires periodically. Like, they're not maintenance free. The Tesla makes it a little less maintenance but, like you know, they're generally maintenance free.

Speaker 3: 31:24

You know they're not maintenance free, so they're not maintenance-free. So the analogy works. It's the same thing I do with people. You know, one of the things I do with my full-arch patients is I'm like, listen, if you're not committed to spending $1,000 a year with me for the rest of your life, I'm not committed to doing your work. They're like what do you mean? I was like you mean. I was like like you, gotta, it's like your car, like would you buy a fifty thousand dollar car and then be like you're gonna end up with another dime at the same thing? You know I'm gonna. I'm gonna run it till the wheels fall off and the oil. You know the oil's empty and the radiator's empty and the answer is no, but yet you not coming in for your maintenance is no different than it. There's zero difference between that and running your car out of oil. And they get it because that analogy works for almost every human on the planet. So, uh, I don't know if that made any sense. You know I absolutely didn't.

Speaker 2: 32:20

I actually love that analogy. I'm definitely going to use that because you're right, when you, when a patient comes in and they look a little bit, you can tell like they look a little like they, they probably should see their doctor. And I think a great way to let them know that without them just going across the street to the other, the next provider, that'll just do it for them. You just let them know, like, hey, listen, you're spending a lot of money. This is a big investment for you. If you're going to spend this amount of money, we want to make sure it works and I don't want you to have to do this twice. So, in order to do that, like, let's at least get a checkup for you.

Speaker 2: 32:57

And a good way to put it to them, to make them understand, is probably something like that what's another big investment you made? How did you prep yourself for that investment before doing it, to make sure it was a good investment? And let's do the same thing for you here. And I think that by telling them that you're not doing it because you're trying to be a stickler or anything like that. You just do it because you care, because you don't want them to lose more money in the future. That'll go a really long way for those patients because you know they probably don't have enough money to get it twice. So let's make sure that they don't have to right. Or let's make sure they don't go through eight months of implants before doing all that stuff and then having to do it again because that's a year of their life right wow, yeah it, I.

Speaker 3: 33:46

And in your you know those things are, so I think those things are so accurate because, uh, um, I always use a line, you know, I use a line all my patients that I, that I truly do believe in, and that is, you know, when I'm when I'm talking to the patients about.

Speaker 3: 34:01

You know, whatever it is, whether I really need them to do a I don't know a chem, dental, or I want them to consider this treatment, I will tell them and say, listen, I would never do anything to you that I wouldn't want done to myself. My commitment to you is like I will never provide a treatment for you that I would not have done to myself in that situation and in this situation, knowing what I know, I need more information and that's for you know. That's for you to get a quality, a quality product that that can have some kind of resemblance of a function of longevity. And listen, their answer also speaks volumes to whether you should either be working on them to begin with. If they don't see that and honor that, that's probably not someone that you should work on to begin with. Right?

Speaker 2: 35:01

yeah, I agreed 100 um.

Speaker 2: 35:03

So I this is something that I want to bring up.

Speaker 2: 35:05

Earlier, when you were talking about, about providers that have come through pathway that you've seen excel greatly, um, you talked about graph and barrett and um pilling and some of these guys, uh, you know, I'm just curious what you're like, what, what are your thoughts on what make a good implant surgeon?

Speaker 2: 35:24

Like what makes a good a surgeon your eyes? Because you know, I have a lot of colleagues that are I'm friends with, I do general dentistry and they just they, um, they maybe want to get into surgery but they're they're not super comfortable with it and you know, sometimes I tell them like hey, listen, um, or, or you know, at the other end of the spectrum is they really wanted to get into full arch and they feel comfortable with it, but they also have a lot of anxiety about little procedures and I, at least my opinion, is, I think it's important to, especially when you're getting into full arch, to kind of be able to manage some of those problems, because there are going to be issues that come up when you're in surgery. And I'm just curious, like what your thoughts are are on, like what makes a good provider that can do these big surgical procedures well you know, um, there are.

Speaker 3: 36:21

You know, we've trained a lot of doctors through here and uh, I have I've seen docs come through here that are in that kind of like I want to do more surgery because I don't really know how. And you know, they take out a bunch of teeth here and sometimes the light bulb flicks and there's like shit. I just needed to be taught how to luxate teeth and how to take things out without breaking bottle plates. And you know, sut, suture, like suturing, suturing sometimes is the barrier of entry to people because they just like, like you don't get it in dental school, right, yeah. And then you also see, and then some of them, some of them contribute, some of them, you know they, they, they thrive in it.

Speaker 3: 37:00

And then some will be like, yeah, we've had people, you know we have a high 90% success rate, that you know that goes and places implants, you know, when they get old. But, like you know, there are docs that, um, there's docs that didn't love it, you know, and, uh, they, they go back home, but you know what, you know what they did, what they will tell you, uh, and some of them are still great friends of mine and they'll tell you, like you know what. What I learned was I learned how to be a better referring doc to my specialists. Like I learned that, instead of writing off my script to my surgeon or my periodontist, you know, put an implant at cheek number 30, you know, I learned from you that, like that, like, hey, listen, like like I, I'd like you, I'd like to play, I'd like you to use a bioreis and implant and I'd like to, I'd like to have it sized where we have a, you know, at least a millimeter and a half of buckle plates, uh, on the crest of the bones, and I need the implant to be centered, mesial, distally, parallel to the contact points, because the final restoration is a scurritate and and I was like, I kind of took me back for a minute and I was just like, yeah, right, like like you'll get better product back by being educated and be able to ask for what you want, instead of just being like, hey, you know, you know, you just put two.

Speaker 3: 38:23

You know, put, you know, replace 30 with an implant. Well, like, you know, like, so it's off. And then you go to the surgeon and just say, well, it was better because of the bone on it you can take some out of the hip Like it takes them off the hook. But what I think is the profile of it is, I think, someone that's looking to be challenged more of their career and I think that that I think surgery is that a little mystical, you know, for the dental student, you know, like every school is different. Like some get it a lot of it. And then you know, like schools that don't have surgery residencies get the the docs get to do more of them in undergrad. Yeah, absolutely, schools that have an oral surgery program in the in the building don't get to do very many.

Speaker 3: 39:14

Yep, you know, they get, they get and they get the insane way and though, and mary, and all the you know all the, all the other things. So I think, but I think surgery becomes a little mystical and the only way to get better at it is through reps, and I think that the profile of the implantologist is that of I need to be challenged mentally and physically, uh, to treat the, the, the patients, and fillings and crowns are doing that for me. Um, does that make sense to you guys?

Speaker 3: 39:57

Like I, I I it's interesting you bring that up because I thought about that, that, that that profile, and that's the best way I could describe it.

Speaker 1: 40:07

Yeah, I think.

Speaker 1: 40:07

Well, I think it's.

Speaker 1: 40:08

It's kind of goes back to when you were talking about Barrett earlier, when he first told you he wanted to go and do Terry's and Zygo's and then all of a sudden he was just jazzed like that, just gave him energy and he just went after it.

Speaker 1: 40:17

And it's always that kind of next challenge and I think Soren and I have talked about this before cause a lot of our training has been just like you know, we we kind of been in the same cadence and advancing ourselves, um, and gone to all the same courses is, you know, we're always saying, okay, well, you know, once I'm competent with doing this, I think that's probably where I'm going to kind of like stop, like that's going to be like that, this is what I do, this is my box comfortable. And as these things become more pedestrian, we kind of start asking ourselves, well, what if we just did like one or two cases? Or what if we just went to this course and then, before we know it, like that's giving us energy and we're and we're chasing after that and I think I think what you just identified is spot on.

Speaker 3: 40:59

Yeah, yeah, it's the. It's the progression of the human right. And like are you, you know? Is dentistry your passion? What I do know I don't know anyone that gets into implant dentistry that dentistry's not their passion. I know plenty of dentists that just do crowns and fillings and hygiene checks and dentistry's not their passion, and I. There's a good delineator there.

Speaker 2: 41:27

I think one of my and this is kind of on topic, but one of my core memories of kind of getting into surgery, because I definitely have the mindset of like I need to be challenged. If I'm not challenged I get super bored and I just like, look for the next thing right. And I always wanted to get into bored and I just like look for the next thing Right. And I always wanted to get into surgery and I was doing a good job in school, I was getting a lot of reps and stuff like that. But one of my core memories that was kind of a gold nugget for me, that hopefully you know some people listening that maybe are dental students or whatever it is might might take a lot out of was I remember working.

Speaker 2: 42:06

I was working under an oral surgeon as a mentor for a year and I I was really blessed to have this opportunity but he, he always was like um, I always kind of looked at him as like a little bit of a crutch where I'm like man, you know, I've been at this, this molar, for for 20 minutes and I and I just can't get it out and I sectioned it and I got there and I got to the root and I feel like the patient's starting to get uncomfortable. Maybe his numbness is wearing off a little bit and I just started to get that feeling in the pit of my stomach and I went to him and I'm like, hey, doc, I'm having a really tough time with this root.

Speaker 2: 42:42

I can't get it out. It's stuck down there and I remember him just looking at me this is Dr G and I talk to him.

Speaker 2: 42:46

I talk about him a decent amount because I do. I learned so much from this guy. But he looked at me and he's like he's like hey, man, you're going to be on your own in six months. Like am I going to be here for you in six months when you, when you come out, like, like go back in there and and figure it out.

Speaker 2: 43:09

And I think that that's like a really important mindset to have when you're learning these initially is just just go through all of the steps that you can, because you know, when you're at a course like pathway right, or you're at one of these courses, it's the easiest option is always to to go and, like ask for help and get someone to help you. But the fact of the matter is, what's going to make you a better clinician long-term is figuring out that solution, to do it by yourself. So I urge people when they are at courses that they have someone behind them that needs help, without doing anything destructive to the patient. But really take all the steps that you can to try to figure it out yourself before going and asking for help, because that's what's going to make you a better clinician long term and being able to kind of like jump over those hurdles is what's going to allow you to get into these more advanced dentistry over time and allow you to do it faster.

Speaker 3: 44:03

I think what you're describing is what I like to call critical critical thinking, yeah, you know. And critical action, right, like, and I think you know, I I think I define critical thinking in implant dentistry. Is this, like you have, you know, science-based, right, like, like, like, like science says we should do this, literature said it shows we should do this. You know, this is the technique that we should do this. But then the other half of it is fucking common sense, like should we do this? You know, is the patient healthy enough for this or do I have the skill set to do this?

Speaker 3: 44:45

So I think critical thinking and critical action comes from blending the known scientific portion with the common sense, like reality you have, and you come together and you exercise something that I think is being lost in society, and that is problem solving. You exercise something that I think is being lost in society, right, and that is problem solving. Yeah, like, like, what you're talking about is going into a surgery and solving for a problem. That is there it's. I think our society is making it too easy to just to just quit, right, I mean the mental health day, day I can't take it.

Speaker 3: 45:30

I'm just like, are you kidding me? I could only imagine if I was on the ranch and I told my dad one day. I was like you know what? I'm not fixing beds today. I need a goddamn mental health day. I can't do it, so I just can't even imagine saying it. But you know what? I bet that the clinic here, once a week someone calls out because they're looking for a mental health day.

Speaker 3: 45:57

I don't read this because I'm struggling with it and it's about looking at a problem using, you know, logic and common sense and critical thinking and problem solving abilities to just solve for it. You know, sometimes, like okay, I set you this and it's still not rolling out. Like, why is it not rolling out? Well, um, it's still hung up. Yeah, okay, like, like, like, where is it hung up now? Like, uh, like you know, on a mower, while a man did it on a mower. Like, well, where am I going to remove more bone at? Well, we're not going to remove it. On the lingual side, that's gone. Like, well, let's take it out away from structures and away from nerves and things that, like, decrease the risk. That's critical thinking, problem solving.

Speaker 3: 46:48

And, to your point, as a young dentist. Like you know, the best medicine is to just stand in there and and do it because you're gonna learn. You're gonna learn what works. And after a while you're gonna be like, yeah, you'll learn after a while. Like you see that you see that scenario on a panel or a cct and you're just like you know what what. Every time I've taken a molar out that looks like that it's taken me an hour. It's taken me an hour to earn $275. And for that tooth right there, that's how much is going to the surgeon, because I can't make any money on that. Yeah, I mean, that's how I look at third molars today. If someone's in the clinic and they need their thirds out, I just look at it and it's like it's not that I can't do it, but it's like is it worth my time and is it worth my post-operative potential complications and time to do that?

Speaker 3: 47:42

It's a liability. If it's not, then here's your referral card.

Speaker 2: 47:50

Learn to overcome obstacles, and that'll also help you become, like you were mentioning earlier, a better referring doctor, right, yeah?

Speaker 3: 48:01

Like I remember in Rapid City, like people are just like oh, I bet the oral surgeons, you know, hate you for doing implants.

Speaker 3: 48:07

And I was like City people were just like, oh, I bet the oral surgeons hate you for doing implants. I was like, well, you know, when I left there I actually don't think that they did, because I did a good job with them Do I have implants that have issues? For sure, all the things we already talked about I the. What they came to dislike more about me was when they got a referral from me.

Speaker 2: 48:31

They were gonna have to work yeah, they're like oh, if mooney sends you a tooth, I'm telling you it's one of three things.

Speaker 3: 48:41

If Mooney sends you a tooth, I'm telling you it's one of three things. It's going to take forever to get out because it sucks. The patient's either batshit crazy and he doesn't want to sit down, or they're sick as hell. It's one of those three things. So for that, like you think about yourself, would you want a referral for any one of those three things? Yeah, no, like, like you think about yourself, would you want a referral for any?

Speaker 3: 49:05

one of those three things yeah but on my, on my podcast during covid, I had, uh, he was the then, uh, ada president, uh, david clements at that tucson, uh, oral surgeon, he was a president, uh, and uh, he was on the podcast and I was doing purpose and I was like, should I? I go surgeon on, I'm like president, or like I'm teaching GPs how to do implants. And he said one of the coolest things ever and said you know, justin, specialists should do special things, and special things are not a bullet bone, missing number 19s, uh, and all the other things that I just talked about are special things. People with misphosphonates, people with health issue, you know, health histories, uh, difficult, uh, anatomy, difficult teeth, all those things like then, that's what they're there for, uh, and that's that's how I use them. And I think to your point, how do we get people to understand how to be better referring doctors and ultimately identify the easier cases and the ones that we can treat, because your patients, we know, don't want to go anywhere else?

Speaker 1: 50:24

How do?

Speaker 3: 50:24

we keep those? And how do we, you know, do risk mitigation and send the risky ones out the door, because you guys know that, like, if you do that really well in your practice, you won't have any issues 100%.

Speaker 2: 50:41

No, I agree Totally and I think that's a really good point to to end on here.

Speaker 2: 50:46

You know we're, we're, we're kind of getting to our our end point here and I think we had a lot of really good topics and a lot of dentists are going to love, love this episode here. You know, we went from from clinical stuff to ethical stuff to to treating patients properly. You know we have a couple. Tyler, I was asked a couple questions at the end here, but I just wanted to give you the floor. Is there anything at all that you wanted to mention at all to our listeners? You know, maybe any. You mentioned a couple new pathway courses, anything else before Tyler asks these two questions and then we kind of wrap it up.

Speaker 3: 51:21

You know, listen, pathway and this will sound funny coming from someone who's trying to sell education but like, pathway should never be everyone's only source of education. Because you've got, like I've taken them all, you know, from Coyce to Picos, to John Russo, to Carl Misch, and it blends in and becomes a part of the way you practice. If you're looking for quality horses that are going to get you some reps, and by good humans, because the criteria to be a mentor at Pathway is, first and foremost, would I let them do an implant on me? Within that group I might be a little bit selective, but criteria would I let them be.

Speaker 3: 52:14

Sometime I'll tell a good story about how Josh McGowan ended up doing an implant on Wade Cullen. It was funny as shit. Wade needed an implant funny as shit. But uh, well, not to. Wayne needed a plan and uh, you know, and it was, and so he had it down at a fast track and like they're all of us, you know mentors sitting around and I'm like, oh, I gotta be the logical one to do this right. And uh, uh, it was funny because wayne wayne's like he goes, you know, like they were hit, did nothing to do with your, your skill set. He goes. But his wayne needed a little sedation for me now and he's just like.

Speaker 3: 52:46

I just knew that when I woke up I'd have a bioreis and implant in there and I was really. He was really looking. He wanted this strong blx in there. Uh, you know, because at the time he wanted a conical implant. At the time bio didn't have the conical implant. So that's what he wanted and he goes. I knew if you did it, yeah, I'd end up with a bio implant. I said, well, what if it worked? He goes. I know. And I said, well, what if it went out? And he looked at me and he goes. I needed someone that was a little bit scared. He goes. You would have been scared and he goes. They need a little bit scared. They need a little bit of that Asian precision and I was like oh, my God.

Speaker 3: 53:30

It was like they're so funny. You know, uh, uh, my criteria. I wrote my criteria. I was like, like what, would I let them work on me? And the second criteria is do they let me call them by their first name?

Speaker 3: 53:40

And this is important to me because if you're going to mentor someone and be a mentor to them, it's not like when we come mentor here, it's not about showing these doctors how good you are, it's about showing them how good they could be. And there's a huge difference in that. And the differentiator in there is ego. And you got to be able to. We all have a little bit of it, but you got to be able to. We all have a little bit, but you got to be able to check that and make it about the patient and the doctor that's trying to learn and not about, like how good you are.

Speaker 3: 54:12

And the third one is would I, would I invite them to my house tonight? Uh, for for dinner and drinks? You know, when I see that outside of the professional setting, and, uh, I, I and you know what we've had. We've had mentors that have come into our, our, our lives and left our lives for you know various reasons, but like those, those, uh, uh, those criteria you know hold true. So, uh, you know, if someone's looking to get you know, uh, in that environment, like we'd love to help them. If there's a course that we don't offer and someone was wondering what it is, I'd help them find the right course.

Speaker 1: 54:52

It's about making the doctor better, not about anything else.

Speaker 3: 54:56

The answer is really simple I wouldn't do anything different. The answer is this If I do one thing different, the three of us aren't talking today, Because if you go back in time and you change anything that you would do, you alter the course of the history and the course of your future and you would not be where you are today. So you could look back and say, yeah, I would have rather done this, I would have rather done that. Listen, I had a guy that wanted to pay me an arch of Bitcoin when it was like $150 a Bitcoin and I was like that's the dumbest shit I've ever earned. I'm not thinking that, I don't even understand it. So I passed off. That could have been a billion dollar arch. That could have been the most expensive arch in the history of Bitcoin.

Speaker 3: 55:53

Even more than a billion, I know right. So for me, um, I would change that, I would change the thing because I love romantic. Good god, I hope I would have gotten that most controversial opinion so large. Uh, how do I get persecuted?

Speaker 2: 56:03

yeah, yeah, that's what we like. We get all sorts of answers.

Speaker 3: 56:15

I dislike all in full and the reasons I'm going to preface it with there are humans that that is the best treatment for. And if you've been a dentalist for a long, long time and I've got unusable sinuses for any pathology reasons or whatever and the only way I can get what the patient desires is to angle some and do a true all-on-four hold, a polo-ballo standard, I went through that phase After learning from him. I went through that phase. People call me oh, you're just old-school Mish style. Well, I still like six implants and I like six vertical implants. Implants still perform. Well, we'll load down the long axis of the implant.

Speaker 3: 57:13

There's, there's, that's, that's science over here, right, uh, but I like six for this reason.

Speaker 3: 57:20

And it'll make more sense when you've been doing this for 15 or 20 years.

Speaker 3: 57:25

And that is, the loss of any one implant in an all-on-four is sometimes catastrophic but at a minimum, a pain in the giant pain in the ass, wow, if you have six A, you've got posterior support, you've got some stabilization and the loss of any one implant in a six-implant system is tolerable.

Speaker 3: 57:54

Plants I can section the bridge, I could graft the sinus and I could come back with a single unit or a small little bridge to replace that section and the full arch in the front is there. If I lose an anterior one, I could just take it out and graft it and do nothing, because I still might have five. I can even suffer the loss of two and still be where I was if I would have just planned and placed them all in force and it and for me that controversial thing is on like hundreds of arches of older, like older technology. I do that a little disclaimer. The technology and some things that we have to do today are better than when I was doing a lot of arches, but at the same time, true risk mitigation is I still like six of them up and down and they look sexy as hell on a post-op panel, and that's my story.

Speaker 2: 59:10

Well, I will tell you that, going off of that, our motto at our company Smile Now is more than four. So when we go in for an arch, more than four every time. Typically for us that means remote anchors, pterygoids, traditional on four on the front, you know, retroframing on the back with the angle. But I agree a hundred percent with everything that you said as far as it's a pain in the ass to lose a single implant in a standard all on four configuration, and that's why we love to tell patients that more than four, if we can do it for you, you're going to be much happier long-term. Yeah.

Speaker 3: 59:50

I know, I know, hey, lifford, I mean I had one little thing on that and that is, you know when I was, you know when I was doing you know Arches and Rapid and United in the clinic. You know Zygo's and Terry's really weren't like an option. You know there wasn't any place to go to it and and having you know, you know having Dan Oldsglaw. You know one of my dear friends and you know having dan oldsclaw, as you know, one of my dear friends, and uh, you know, having taken his course here and learned, like, um, I think differently about, like you know, before I met dan and stuff, like I was like you build the sinuses, you, you, you drop them in vertically and and there's still cases that uh, call for that because I can. Someone asked me that day, like why don't we even do a scientist anymore? Why don't you just do some terrorists and some things? I said, well, I said, imagine this scenario and I'll challenge you guys for this Like patient comes in, can't afford, just absolutely can't afford, can't qualify for a loan to do. You know the full arch as it is.

Speaker 3: 1:00:56

So imagine a scenario where you can go to mrs jones and say you know what, let's phase this in so that you, uh, uh, could get what you need over amount of time and right. So here's what we're going to do today, like we're going to, we're going to get these disease teeth out of here. We're going to graft the holes, uh, and we're going to put you into an immediate denture for about four or five, six months, you know. And then, uh, that's going to give your, that's going to give your pocketbook a chance to kind of recharge from like this. Yet you know, which was, by the way, was still profitable in practice for what he did, uh, and then you're going to move to phase two, which is we're going to place the implants. Now, what if we don't have any other? We don't have any bone anywhere. Uh, the patient can't afford the, the exotics, the xytos and the cherries.

Speaker 3: 1:01:43

Imagine a scenario where, especially in today's economy, where you want links, jones, phase two is I want to do some bone grafting at both of your, the upper left and the upper right side, and it takes about 10, 12 months for it to like really be good bone. So things two is you know, it's about five, six thousand dollars, but you got 12 really strong. You got 12 months to to to heal from that financially, and that phase three is going be. We're going to put the implants in and they need to heal as well and they've got some time and so they're going to need six, eight months of hearing and then the final thing is what you actually want and that's the teeth that you can smile with and chew with and do those things.

Speaker 3: 1:02:29

And yes, I just talked to you about a, a two-year-old program, you know, maybe even a little bit more, but you know what I can get you. What you need to have. It's going to be super sound and is probably as good as we could probably uh, make it. And I've got you from point a to point b. You know, financially it like sometimes we're so ingrained in like racing to the finish line with full arch that we leave some people behind because it's either full arch or nothing.

Speaker 3: 1:03:02

But what I just told you is more affordable to a lot of people. And guess what? You've got four phases of pre-regretting. You've got four phases of regretting it and if you hadn't have taken that patient out two years, you'd have got zero going, zero out. So I think that goes back to that thing. If you open your mind to hearing what the patient has to say. Like man, I can't afford that then get super creative at problem solving. You know, sometimes the problem solving isn't for the for the work itself, but if the problem solving is for the financial pocketbook like how do I, how do I problem solve for the patient? And that is, let's break this up over two years, because if you're, if you're planning on being in the same location for more than two years, like that's a goldmine patient, yeah, it's great. It's great and they got served.

Speaker 1: 1:04:00

Yeah, I mean, I don't think that that should really be that controversial, you know, and I think that if we're thinking about long game and you've inserted yourself into a community and you want to benefit that community and give back to people and, you know, not everyone's going to be ready for full arts there's a lot to be said for getting multiple bites of the apple, being conservative, not making everybody fit into the same box, um, so I can definitely appreciate where that's coming from and ultimately, you know, being a pillar of your community, giving back, it's extremely important as a dentist well, listen, I, I appreciate you guys, uh, having me on your podcast.

Speaker 3: 1:04:33

Uh, I love following you guys. Um, I, uh, I love what you said about giving back like, listen, you're, you're going to have amazing careers and you're, you know, you're going to provide for yourself and your families and that's like, that's not even a, it's not a thought, it's a given. Uh, and you and you know, as you move through this and this podcast goes a long ways as you move through life, remember how you got here? Was someone blazing that trail or leading the path? And you guys are approaching the trailblazing status and don't take that lightly. You know, like, like, drag some people, drag some people along the way because, uh, uh, it's, it's where the, it's where the real gold is.

Speaker 1: 1:05:22

Uh, it really is Well, I, I certainly appreciate you, uh, saying that, uh, it's. It's very generous of you to say. I mean, with our little podcast here and our audience, we're very humble about what it is that we're doing, but at the same time, I couldn't agree more that you know, having seen what you did with Implant Pathway and all the people that you've brought along to success with you, it's inspiring to us to do something very similar. This is not about money or status or titles or anything. For us, I think, at the end of the day, those are things you can't take with you at all, um, but what you can take is, uh, the friends you make and the colleagues you make and being able to practice without living in a silo, and really that's why we started this podcast and and uh, create this community and, um, you know, for us, the person that dragged us along was you, so we really appreciate it.

Speaker 3: 1:06:08

Yeah, yeah, for that I appreciate you saying that, because, for that, like, uh, that makes me, uh, you know, that makes me whole, you know, because that, uh, yeah, being able to call you guys friends and then it'd be on your podcast and stuff, that's uh, uh, yeah, that's, that's better than that's better than titles and money and all the other stupid shit.

Speaker 1: 1:06:47

So, yep, yep, yep, yep, because we think about our own careers and our legacies, the impacts that we make with our colleagues and with our patients as well, and there's just so much to say for what you've contributed to the field of implantology, all the people that you've inspired to be doing this, and you know you're one of those forefathers, so to speak, that's led to things like this existing. So I think we've asked far too much of your time and really appreciate you coming on. We've asked far too much of your time and really appreciate you coming on, and hopefully we'll get to get you back on the show again some other time to talk again about, you know, whatever other beautiful way that you've impacted our industry has been. So again, thank you so much for coming on and we hope the audience enjoyed as much as we did.