The Fixed Podcast

A New Approach to Residency Education with Dr. James Rutkowski: Part 1

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Unlock the secrets of modern implant dentistry with Dr. James Rutkowski, the visionary director of Jacksonville University's Comprehensive Oral Implantology Residency Program. Dr. Rutkowski takes us on an extraordinary journey from his early career as a pharmacist to becoming a trailblazer in implant dentistry. With stories of placing his first implant back in 1983 using makeshift tools, his narrative is both inspiring and enlightening for anyone passionate about advancing in the field. Discover how his dedication to education and innovation has shaped a residency program that is setting new standards in dental education.

Immerse yourself in the transformative power of a residency program that weaves together the complexities of pharmacology and implant dentistry. This unique curriculum offers a holistic approach, equipping residents with the skills needed to navigate the intricacies of real-world clinical settings. By integrating diagnosis, surgical placement, prosthetic restoration, and maintenance, the program prepares dentists like Soren and Tyler to tackle complex cases with confidence. Residents also benefit from hands-on training and the opportunity to earn a stipend, ensuring both financial stability and comprehensive education.

Explore the myriad benefits of this pioneering residency model, which blends academic rigor with practical experience. Dr. Rutkowski and his team have redefined dental education by emphasizing community, collaboration, and continuous learning. With access to a network of clinics across the U.S., residents gain invaluable experience while patients receive affordable care. This innovative approach not only enhances the residents' skills but also supports their professional growth, offering an enticing alternative to traditional dental education paths. Join us for an engaging discussion that promises to expand your understanding of what it truly means to excel in implant dentistry today.

Dr. Tyler Tolbert:

My name is Dr Tyler Tolbert and I'm Dr Soren Papi, and you're listening to the Fix Podcast, your source for all things implant dentistry. Hello and welcome back to the Fix Podcast. Super excited for our guest today, dr James Rakowski. He's on. I got connected with him through Dr Todd Erickson, so shout out to him. He was a fan of our show, had been listening to us for quite some time and, uh, he wanted to tell us about this uh residency program that he was directing.

Dr. Tyler Tolbert:

And uh, we talked a good bit about, uh, what they were doing over there. And you know, there's not a whole lot of uh residencies that when people reach out to us and they're asking about, uh, what kind of programs that they should be looking into out of school if they're trying to get into implants and are really serious about surgery, there's not a lot of programs that we really point people towards, not necessarily because there's not good programs out there, but just because it's hard to find programs that are really a specific funnel for what it is that we do. And as soon as I heard about the kind of caseload that these dentists are able to do, I was really impressed and this is certainly a program that I'm steering people towards uh myself. So, uh, he referred me over to Dr James Rakowski.

Dr. Tyler Tolbert:

We have uh here with us today, who's going to be talking about uh, the Jackson Jacksonville university comprehensive uh oral implantology residency program. It's a bit of a mouthful, um, but that's because it's a. It's a load of content as well, so I'm really excited to hear about all the things that you guys are doing and hear a little bit about your story. So, dr James, thank you so much for coming on. Well, thank you for the invite and thank you for the interest in our program.

Dr. James Rutkowski :

Of course, it's really appreciated that there are people that want to see to it that those that are doing implants get the finest education that they possibly can get, and that's what drives our program and drives all our residents.

Dr. Tyler Tolbert:

So thank you for having us For sure, for sure. So I'm hoping that you can give us a little bit of context you know really about yourself and your own background in implantology, how long you've been doing it, your own training, and just kind of walk us through what got you to being the program director of the year today.

Dr. James Rutkowski :

Okay, well, I started out as a pharmacist.

Dr. James Rutkowski :

I graduated from Duquesne University School of Pharmacy in 1972, and from there I went directly into dental school, where I graduated from the University of Pittsburgh in 1976. And then I went into general practice and I immediately saw that there was a real problem with patients who were missing teeth, particularly full arches, that lower dentures in particular. There was nothing that you could do that would really make it work. Occasionally Maybe you get the one or two in a hundred that just said I love my lower denture, but you got got 98 people who said isn't there anything better, doc, and distal extension, partial dentures and whatnot.

Dr. James Rutkowski :

So I started taking implant courses from Midwest Implant Institute with Dr Jack Hahn and Dr Duke Kellett, as well as many other people Lenny Linkow, those people that have gone before us and I've been able to stand on their shoulders and see what was possible. They took care of a lot of the initial issues for us. I placed my very first implant in 1983, which we did not have any kits went to the hardware store, got some drills, got some. I think they were called osteotones.

Dr. James Rutkowski :

They were really leather balls we sterilized them, tapped them with some foam and we put these implants in and I could see that there were some real issues with the way we were doing things, but it was all that we had.

Dr. James Rutkowski :

I stayed with it, did a fellowship with the Midwest Implant Institute as well as other courses, got very active in the American Academy of Implant Dentistry. The AAID Continued on, got my associate fellowship, my fellowship with the AAID and then my diplomate status with the American Board of Oral Implantology and Implant Dentistry. Was doing a lot of bone grafting. I was one of the earliest adopters of implant dentistry in Pennsylvania, in western Pennsylvania, where I practiced. I moved to a small town because that's where my wife and I wanted to raise our children. And so there I was. I was in central Pennsylvania in a small town and wanted to do implants and people said you'll never do them here. But lo and behold, there were people there that needed implants. But lo and behold, there were people there that needed implants and we started doing them and we traveled and we built a practice that was very heavy into dental implants.

Dr. James Rutkowski :

I was doing a lot of bone grafting. I realized that we had a lot of deficiencies with bone grafting and my wife and I became empty nesters. Our kids were out of college, so I decided I would go back to school. I always had a strong interest in pharmacology and to me everything that we do is pharmacology, whether it's signaling of bone cells to go ahead and start osseointegration or de novo bone formation force. So I went back to duquesne university. I kept my my practice three days a week but I went back to get a PhD in pharmacology at 51.

Dr. James Rutkowski :

I finished that seven years later, when I was 58. I put a research laboratory in my office. I actually hired technicians to help do that research. I had to know how all the research was being done because I had to do my defense. But actually doing it, um, I had people up that would be working with all the cells and doing all the things for it and whatnot.

Dr. James Rutkowski :

And so at 58 I graduated with my phd and, uh, started with some of those things into practice in the clinical practice, opened up a research company called the clararing research group. We developed a small molecular compound, small molecule, that synthetic that shortens the sigma for bone formation from 16 weeks down to about 10 to 12 weeks predictably, and started to work with some people in orthopedics and our products started to be used in spinal fusion on a research capacity clinical research as well as dentistry and also took a strong interest in postmenopausal women and the issues they have with bone formation and their estrogen levels, and so we did a lot of research with that, with the research company and Salivary Diagnostics for these people, these individuals. So it's been a great ride.

Dr. James Rutkowski :

I continued to practice until I was 70, although, I must admit, beyond the age of 60, it was only two and a half, three days a week, because I was involved in the research the rest of the time and I left clinical practice in July of 2020 and I was doing just fine with all the things that I was doing. I was doing CE lecturing, with maxi courses as well as other invites, and was enjoying life. And then the Jacksonville University program. They reached out to me and asked me if I'd become director and I said initially, I said no, that's okay, everything's fine, thank you for thinking of me.

Dr. James Rutkowski :

And they came back in about a month and they said well, you're going to do it. And I said well, actually I thought I answered that question. And they said well, we'll give you another month. And I said well, I don't think it's going to change. And then the dean called me and he and I hit it off we, we hit it off and my, my wife, could overhear the phone conversation and she said to me she said well, how did that phone conversation go? Remember, you're retired now. You don't do everything.

Dr. James Rutkowski :

And I said yeah, but I'll tell you what I think we can make something happen, and so I said sure, and I'm glad that I did. It's kind of like when you go to the dog pound and they hand you the puppy. Once they hand you the puppy, you can't give it back. You're going to take it home, and that's exactly what happened with this program.

Dr. James Rutkowski :

I'm very energized by our residents. They are outstanding individuals, they are dedicated, they want to do the very best they can, and that's what drives the entire program. Let's just make the best educated implant dentist, because implant dentistry is so complex, whether it be the surgical component of it, the bone grafting component of it, just taking the tooth out how do we get the tooth out? What we're going to do to grow the bone, put the implant and that old excuse why put the, the implant where the bone was? Yeah, that worked in 1988.

Dr. James Rutkowski :

It does not work in 2025, though, and so we know a lot more now than we did in the 80s and 90s, whether it be implant services, thread design, treatment planning, methods of treating prosthetics, everything at pharmacology, medical evaluation. All these patients come in, they are in their 70s, 80s and 90s, they have a long list of pathologies and a long list of medications, and all those things do affect the results for us. So we've just put together a program where we get to be able to bring everything together to help these young doctors and middle-aged doctors. I'm surprised at how many middle-aged people we have coming into the program.

Dr. Tyler Tolbert:

Wow, wow, yeah, that is a quite the illustrious career and I really commend you for your commitment to education and and taking on all the things that you took on. I mean having a doctorate in pharmacology, in addition to all the things and your contributions to implant dentistry and the research and everything. I just it doesn't seem like you've had enough time to do all the things that you've done. So I really commend you for all that and also praise you for continuing to recommit yourself to a whole new thing into your 70s. So that's, that's really fantastic and there's there's a lot of different avenues we can go down and I'm also very curious too, and we can certainly get into this.

Dr. Tyler Tolbert:

You know, aside from talking about the residency itself, is you know? You kind of already alluded to it is you know the? I think your pharmacology degree has only become more useful over time because polypharmacy and what we do is more common than ever before. I mean, I've had a patient I sent it to Dr Poppy as well that had literally just 20 pages of prescriptions and I said you know, I'm going to look through here and see about the things that I know about. There are going to be contraindications, but as far as how all this works together as a system, I couldn't tell you, so I'm sure that's certainly come in handy for you. But yeah, soren, did you have anything to glean from all that? That's quite a repertoire.

Dr. Soren Paape:

I mean, I just I really appreciate the fact that you know, we we as as younger dentists in the profession of implants, you know, benefit greatly from, from people like you who contribute to the research and, like you said, like the advancements in grafting and techniques like that. You know, I feel like Tyler and I have come into the into the implant game while, while there's so many things that have improved before us, um, and it's, it's allowed our job to be that much easier, when, not that it's an easy job, but you know from, from where you were at in the eighties to where we're at now, uh, it's we've come into the profession at such a good time where there's a lot of advancements in these techniques and we're able to provide treatment for patients that they weren't able to get before, and we're not going to the hardware store for our instruments anymore.

Dr. Tyler Tolbert:

Yeah, absolutely.

Dr. Soren Paape:

I would love to hear more and I'm sure our listeners would love to hear more specifically about the residency kind of like time lengths of it. I know you were talking a little bit about it prior to the episode starting so just what the residency is, how it differs from other residencies, what people in the residency can kind of get out of it, and I think that would be excellent for our listeners.

Dr. James Rutkowski :

I think that would be excellent for our listeners. Okay, Well, great, let's just start how our residency differs from the other residency programs that are out there, whether it be oral surgery, peri or cross, that do have an implant component to it. Those residency programs, if it's the oral surgery, then they are looking at it from a surgical aspect. That's where they put their emphasis on it and they do place a reasonable number of implants in their residency programs. Typical six year residency in oral surgery they may place 70 to 100 implants, of which they don't restore any of them. Okay, so they put them in and then they never get to see what do they look like, necessarily. Or maybe they do get one post-op when they do see that the actual prosthesis in place, but they're not there and seeing. Well, you know where, their complications and whatnot.

Dr. James Rutkowski :

Perio, and they contribute all these perioprocess oral surgery. They contribute a great deal to implant dentistry and they certainly have a place in implant dentistry. But so do general practitioners, okay, Because implant dentistry is oral surgery, perioprocess and a big component of general dentistry. So in perio, you know they focus on, you know the soft tissue, the aesthetics. They know the literature extremely well. They've contributed to the volume of literature greatly. Who knows prosthetics better than a prosthodontist? Absolutely nobody. They know their literature and whatnot but they don't necessarily get to do all the surgical placement.

Dr. James Rutkowski :

Where our program brings everything in implant dentistry together is the diagnosis, it is the evaluation of the patient, it is the treatment plan, it is getting acceptance of the treatment plan, it is the surgical placement of the prosthesis or, excuse me, of the implants. It is the managing surgical complications, most immediate and maybe long-term, and how you prevent all of those. Then our program, also our residents, not only did they place those implants, but now they restore those implants and so then they deal with the prosthetic planning. And that had to be all done before they ever started the case, obviously. But they deal with that prosthetic planning at the beginning and then doing that prosthesis for them, then maintenance, that prosthesis what kind of complications were there, you know? Does the patient come back and say you know, I really can't get my floss threader in there, which you know that didn't, wasn't necessarily a concern of the oms, you know. Well, you got to see the prosthetist for that, you know. And the prosthetist goes well, you know, that's where you put the implant and that's they're too close together, that's the best I can do.

Dr. James Rutkowski :

So then there gets to be this finger pointing where ours, the program, is. They do it all start to finish. They do reach out and rely on the other dental specialties though when they feel that it is necessary. So this isn't it's all us and just us. No, we believe that implant dentistry involves everybody. It's just that we're trying to educate a dentist who can take the case from start to finish, either themselves or in conjunction with others, so they make it all work together. Then in our residency program, they also follow these patients afterwards so they see what it looks like in six months and a year. Another big difference to our residency programs is it occurs in the real world. It occurs in clinical practices. Across the United States Right now we have 21 different clinical sites where we have a total of 27 different residents. Some of the programs have more than one resident, but they are in the real world. Now, that real world may be private practices where you, you know, they hear about the patient saying something about well, you know, I, I don't like the price, I don't like the fee, or, you know, when it's all done, I don't like the shade or I don't like this, and that were that if you are in a dental school or a hospital you don't necessarily get to hear all those things, because there is a

Dr. James Rutkowski :

billing department that takes care of all that billing. There is a department head that has to put up with that. Somebody is unhappy, there are complaints about the end result and so you know you've got a department head or a dean who's taking care of all those things and you're not necessarily we're here. You are the one that's involved with this patient. You have a resident director that works with you and supervises you. They are people that are well experienced in implant dentistry. Whether they are oral surgeons, periopros or diplomates of the ABOI or diplomates of the ICOI, individuals will have a great deal of experience that can supervise these residents as they go through their program with it.

Dr. James Rutkowski :

So our program is, I think, the most well. I don't think I know. It is the most comprehensive. And not only is it comprehensive clinically but then didactically. We go into great deep dives in every single topic. I know there's topics that in continuing education they may get an hour lecture on it or a four-hour lecture on it, where in our program that may represent a six or eight-week didactic lecture that they are actually evaluated, assessed on, because there are homework assignments, there are quizzes and tests that they have to take, final examinations, there are papers that they have to write. So there is an assessment, there are assessment tools in place where in the CE world you don't necessarily get that place, where in the CE world you don't necessarily get that. And now you asked me several questions there, dr Poppy, and I think I only got through the first one.

Dr. Soren Paape:

I don't remember all the others no, and I actually have a couple of questions now, after you said it. I think the others were number of residents, which I think you answered you said 27, correct? And then I asked length of the program, and then I wanted you to elaborate a little bit on. You talked about how you get your master's in the program, but I don't think you discussed that just now. So a couple of those details would be great, great.

Dr. James Rutkowski :

Well, the program currently has 27 residents, of which we'll be graduating our first cohort at the end of April. That first cohort only had five residents, so that'll give us 22. But as of December 31st we have 16 residents who have been accepted and are into the program. They are matched with their sites but but we probably have another five or 10 that will be coming in. So this incoming class will be a minimum of 16, but probably more. So that would take us to 38 residents and we might actually end up with 40, 45 residents going forward.

Dr. James Rutkowski :

The program is currently a three-year program but we have made petition to the university and the university is very much in favor of it is to reduce the program from three years to two years. When I took over the program at the end of its first year, I took a hard look at that curriculum and I said, ken, is there anything I can streamline here? It's still deep dives into everything. It's just I'm making the best use of everybody's time and the university is very much in favor of it. So I full well expect that the program will be a two-year program and those that came in in cohort three in July of 24, they came in on the three-year program but they are going to morph into the two-year program. It's the second and third year that got combined. The first year stayed pretty much the same. Second and third year got combined so we'll have two classes of three years and then the third year, cohort three and cohort four.

Dr. James Rutkowski :

They will be two year programs. They are year-round programs. It's on a tri-semester and they do their clinical work in the clinic. We want them to be in the clinic eight to ten hours a day, a minimum of three days a week. They do their didactic portion Monday through Thursday, 8 to 9 30 pm Eastern time. It is done virtually All the lectures are reported so they can do it asynchronously. So if somebody cannot make a lecture on a Tuesday night because a lot of our doctors they have families or they're starting their families or they're out looking to make a family, they've got a date on Tuesday night and they can't make it, they can binge watch over the weekend, get caught up on all their homework.

Dr. James Rutkowski :

The homework assignments are usually due two weeks after the presentations. There are reading assignments. We encourage them to attend as many lectures as they possibly can. Some lectures they must attend because they have to do presentations to and whatnot, but for the most part they get to do it asynchronously, which that certainly helps, but that is a full-time program. They get to do it asynchronously, which that certainly helps, but that is a full-time program.

Dr. James Rutkowski :

The clinical portion of the program is based on entrusted professional activities, epas, entrustable professional activities, and they start out with the simpler things, or the things where you would start, where it is onboarding a new patient, an examination, medical evaluation, pharmacological evaluation, dental evaluation, presenting the case to the patient, the treatment plan, getting acceptance of the treatment plan so that's one epa getting informed consent and doing all that. That's one epa. Then other epas they may start, start out with a single implant in the non-aesthetic zone, no grafting necessary. Then maybe in an immediate implant in the non-aesthetic zone, then maybe a single implant in the posterior maxilla, where you do have to do a sinus intervention, whether it be a crest or a lateral window approach and then posterior mandible etc. Full arch treatments, the set zone, multiple implants in the set zone, fp1s, twos, threes, rp3s, fours, five so you know I'm the awful party fours and fives, so the whole spectrum of it.

Dr. James Rutkowski :

They do an IV conscious sedation program that lasts about seven months. Now that they do have to go to Dayton Ohio, for they have about six visits to Dayton Ohio for that IV conscious sedation program, but they do get their IV sedation permit. It is the most rigorous IV sedation program in the country. It's accepted in all 50 states. Some IV sedation programs are not accepted in some of the states. Ours is um dr steve shuffleberger, who many people already know uh, is the instructor for that program and it is a very rigorous program.

Dr. James Rutkowski :

Um. So these epas, they they go from those basic things to where they then the full arches as well as zygomatic implants, pterygoid implants, and if the clinic they're in does not necessarily perform some of those procedures, then they will rotate through other clinics where they may or may not be able to get to do those procedures in those clinics because they may not have a license for that state, but they will at least assist in them. Then they will write a paper on that and then they will sit with for an oral examination from me to assure that they really do have a good understanding of all of those procedures. Um number of implants, I just talked with one of our residents who in his first two years and one semester has placed well over 600 implants, has currently restored 90% of them and has done 60 full arches.

Dr. Soren Paape:

That's excellent. Yeah, that is a very robust education yeah, plants well, I'm surprised you guys. You guys are even doing remote anchorage, like zygomatics and and pterygoids. That's, that's very cool. Um, so do you guys have clinical suites where, like so, each resident is in like a different clinic and then they're? How does that work exactly?

Dr. James Rutkowski :

right, yeah, so, um, we have. We have these 21 clinics all over the united states and, uh, some of them are just private practices. Uh, others are, uh, 501c non-profit clinics where patients go there and they get their implants done at a reduced fee. But even in the private practices, many times those practices. They will have their standard fee and then a patient may say gee, I can't bite off that much. Is there an alternative? And instead of giving maybe an inferior implant alternative?

Dr. James Rutkowski :

they say well, we do have another treatment method for you, where we have a resident from Jacksonville University who, instead of assisting me in this case and they have done these cases they've assisted.

Dr. James Rutkowski :

You know, this is the director speaking. My resident will do the case and it might be at a 50% to 75% of the normal feet, so that entices patients to stay with it. We have many manufacturers who we have partnered with who give substantial discounts to the clinics for the cases that the resident is doing. So they get the benefit of paying less for the implants, less for the bone graft materials, less for the membranes, barriers, the whole nine yards, the digital hardware, the digital software that needs to be had. We have companies that give discounts for every single thing that is done in implant dentistry and that entices these private practices to say you know what I can bring in. We call them associate residents, where they are to do whatever an associate does in that practice. That means a re-exam, a new patient exam, take care of an emergency, you know, and if it is a non just 100% implant practice, they might have to sit down and do a composite restoration. They might be doing an occlusal or a do on number 15 that's sadistic.

Dr. James Rutkowski :

Now, I personally think that's harder than doing some implants, oh it is oh yeah, it'd be a nightmare, but they have to be contributing to that practice and you know what I that practice and you know what I tell all my residents.

Dr. James Rutkowski :

you know what, if an assistant calls in sick that day or they have a sick child and they can't come into work that day and they need someone to help seek patients, help scrub instruments, help clean rooms, guess what? And even though I practiced for 44 years and I was seven years old when I quit you know what? If we were short-handed, I pitched in and did it.

Dr. Tyler Tolbert:

Yeah, that's right. Oh yeah, that's awesome, a hundred percent. You know we we get asked all the time about. You know the decision point between do I go into a residency after school or do I just go straight into private practice. And just you know, take a bet on taking a bunch of CE and because you know you're in private practice, you're making private practice money, you can pay for the CE. You're doing these weekend courses, the week courses and things like that.

Dr. Tyler Tolbert:

And I think it's always a, it's a calculus of, well, how much are you learning over a given amount of time and you know how much are you progressing and what are going to be the returns over time for how much you've learned in that given amount of time.

Dr. Tyler Tolbert:

Right, and I think the case is with so many residencies is they might be two, three year programs and you know you might come out having placed 15, 20 implants and it's like, well, you've spent a long time learning a bunch of stuff didactically speaking, but in terms of reps, you didn't really get a ton of reps during that time and so there's not as much of a return on investment but what you just described in terms of what these residents are doing in a private practice environment and in the breadth of skills that they're learning and coming into contact with, all the way up to remote Anchorage, getting their IV conscious sedation, which is, you know, a pain to do while you're trying to balance, you know, running a business or what have you?

Dr. Tyler Tolbert:

Going through all these different competenciesencies and getting that kind of volume. I mean that is a two years incredibly well spent. That is going to, you know, have a absolutely massive return for all of your residents for the rest of their careers and that's really an accelerant, in my opinion, and I wish this kind of thing were around when I was coming out of school, because in the fact that you guys make this available to general practitioners is just a it's it's a career hack and I'm really, really impressed with you guys have put together and I love the private practice component of that. That's not something I was actually aware of before we got on here.

Dr. James Rutkowski :

Yeah, that and and you know, I I have had discussions with a couple of dental schools, a couple, of prosthetic residency programs, some AEGD residency programs, where they say is there some way that we can partner with you or just how are you doing this? I mean, I had one dental school recently where they actually closed their implant dentistry department because there was a conflict, internal conflict, between oral surgery, perio and pros at this school and implant dentistry. Because the patients were coming for implants and said, well, yeah, I'll go to the implant dentistry, I'll go to implant dentistry. So all the patients that needed implants were going to implant dentistry. They weren't thinking, you know, I'll go to oral surgery, pros or perio, and they were being directed internally in the dental school to the implant dentistry department because they needed implants and that created an issue within the school and so they had

Dr. James Rutkowski :

to close the implant dentistry department because it was in competition with oral surgery very on cross. And I, I don't want us to be in competition with with anybody, I want us to just be out there giving the best education, right, and that's where this dental school, they said so let me get this straight. You have your residents out there in the real world all over the united states, not competing with any dental school. And we said, yeah, that's what makes it work. Our residents. We want them to spend a minimum of three days a week in the clinic. For that the clinic has agreed to give them a stipend of $50,000 a year. But we strongly suggest and the agreement is between the resident- and the clint site.

Dr. James Rutkowski :

What we suggest, though, as the university, that if their collections goes beyond 200 000, after lab fees are paid, then they get 30 of their collections. That also allows them two days a week to go out in moonlight in a practice and just make some real money. So we have many, many residents that are making 80 to 100, 150. I have one resident who's making $180,000 a year, and I got to admit now, the first three or four months it's kind of a push. You know they're new, they're just learning. And then those of you that have had associates, you know you get an associate the first three, four months nobody wants to go to them. You know they want to see a pain doctor, et cetera. You know those kinds of things it's a little bit awkward, and you know you got to get their feet wet, and you know security and plan on the ground, and so the first three, four months it's a push. They may not be earning their keep. But then I have resident directors tell me that after they're there, five, six, seven, eight, nine, ten months hey, man, this is a big win for me because I've got someone who is dedicated for two years, because so many times associates come in. They stay six, nine months, get their feet wet and they want to go Right. Well, here they've got a two-year commitment to them and then also it's an avenue for future partnership or buyouts with them. And I, you know, I think the associate resident model works well.

Dr. James Rutkowski :

The university confers a master's degree. It is not a code approved program, because implant dentistry is not a specialty. It's not a code approved specialty program. But we are approved by and accredited by sax, that's the southern association of colleges and universities. Um, that's where we get our accreditation through, so we're able to show a master of science degree in dentistry with a certificate in comprehensive oral implantology. And then I'll talk about another whole avenue we have here in a few minutes.

Dr. Soren Paape:

Yeah, that sounds like a win-win for everyone. I mean, you know, I think one of the major concerns, like you said, are in like a dental school setting or like a residency setting, is number of reps. Right, like you only have so many implants that need to be placed by however many providers you have at a single location. So the fact that you guys are instead doing it where you have X amount of 21 clinics across the US, one, that's great for the residents because they don't need to move their entire families in some situations to, like a certain university, they're still getting their master certain university, they're still getting their master's degree and they're making an income while the you call them the head of the clinic, right?

Dr. James Rutkowski :

Like the what was it?

Dr. Soren Paape:

Yeah, resident director, the resident director. It's kind of a win for them because they're essentially getting an associate for a low fee, right.

Dr. James Rutkowski :

So it's a hack it right, it's a hack, it is, it's a win-win.

Dr. Soren Paape:

The residents are getting amazing reps that they wouldn't get in a private practice setting. It sounds like someone's over their shoulder for some of these procedures and I could see it being extremely beneficial. I agree with Tyler that if something like this was around when we were coming out of school, it would have been excellent. Instead, tyler and I spent many, many nights up until midnight 1 am just studying this stuff. My background is I did a year under an oral surgeon and basically we were rounding in the hospitals until midnight every single night just to get my surgical reps in. And I know Tyler took so much CE on the weekends and he did his IV course.

Dr. Soren Paape:

Like all this stuff people don't realize Like a lot of people will come out of school and they'll be like, okay, I'm going to go to these CE programs and get these reps, but what ends up happening is life just happens right when all of a sudden, family time, all of these things occur and it just gets pushed off and off and off and they might never get that education that they wanted to when they came out of school.

Dr. Soren Paape:

So I see something like this being extremely beneficial for someone that's looking to get into implants. And another thing that I hear from my colleagues a lot who are doing general dentistry they get all these promises made by going into offices by associates. In their associate they're told like, hey, yeah, you're going to get a bunch of surgery, you're going to get a bunch of implants. And then what ends up happening is they go into these clinics and the primary provider is like, well, I'm actually going to do those implants because that's the moneymakers, right, and you take these patients or these early cases, and a lot of times they don't get that experience that they were promised, right. So being able to kind of guarantee those reps is so powerful and it'll get like two years.

Dr. James Rutkowski :

In a program like this it's probably 10 years of CE that they would be taking outside of the clinics. Our tuition when we go to the two-year program will be $37,500 a year. So for two years it would be $75,000. But if you take all of the courses that we offer, both didactically and in the clinical that it comes into with the IV sedation it comes into about, if you went out and just did it with CE, it would be about $135,000. Oh yeah, plus you would have had airline. Yeah, I mean sedation alone could be $15,000.

Dr. Tyler Tolbert:

Oh yeah, plus sedation alone is 25. Yeah, pardon, I mean sedation alone can be 15, $25,000. Just just that.

Dr. James Rutkowski :

Yeah and um the uh, so you know you don't have airplane tickets to buy, of course. Yeah, oh yeah. You don't have hotel bills. Uh, you get to come home at night, you get to be with your family and not away every weekend. When I'm like you guys, I mean I came up the CE pathway and I mean a lot of weekends are great, it's expensive.

Dr. James Rutkowski :

I work till 5 o'clock, 6 o'clock, get in the car, drive for four hours, get in the hotel, stay there for Saturday and Sunday lecture, drive home and get back home on funny night at midnight, 1 o'clock in the morning. Get up the next morning, monday, and go into the office and start working again all over and miss that whole weekend with my family.

Dr. Soren Paape:

Oh yeah, and what Tyler and I typically have done is we have to take weeks off of our clinics to go overseas, right, so you spend $2,000.

Dr. Soren Paape:

Spend two, three thousand dollars on a flight overseas and then you have a hotel there for a week and then you got to factor in your um the cost of closing your clinic down for the week, right production costs for that week on top of a course. That's typically a lot of. These courses are 20. You know these like remote anchorage courses, zygomatic implants, you you can be paying up to 30 K uh to get you know a week's worth of a course. Um and, and that's a whole year for your guys' program, which is excellent.

Dr. James Rutkowski :

And and and you, when you place those implants, you never get to see did they work or not.

Dr. Tyler Tolbert:

You're run through it. I mean you're you, you're lucky to do. You know a handful of cases and you don't ever see them again. You have no idea how they turned out. You know you're just seeing a snapshot of that process and you're still, I mean, paying so much for it.

Dr. Soren Paape:

And I think the most important thing when going to those programs is, you know, anybody can put a screw into bone right, like a zygomatic implant. I mean, the zygomatic implants are obviously more complex than that. But what I'm trying to say is the complications. That's the difficult part and that's the part that you should be paying, because once the zygomatic implant's in, that's one thing, but handling the complications after the fact, that's the most difficult part, in my opinion.

Dr. James Rutkowski :

You're absolutely right and you've got to be able to experience everything that goes with implant dentistry if you're going to place implant dentistry and you have to know how to manage it. And when you go and I've taught those courses in Mexico and whatnot and people come down, they do them and they say, okay, well, I did a science lift, now I'm going to go back and I'm going to do it. Then they're reaching out to me because I make myself accessible to them. They reach out to me and they say, hey, jimmy, and I was just an instructor brought in, it wasn't my program, but I got this problem. I got this. What do I do? What do I do? And they're in surgery and they have no idea what to do because they don't have anybody looking over the shoulder.

Dr. James Rutkowski :

We're here, you've got an experienced director who you know you can be in there and your epa's and trustable professional activities is is after you do it. That's not just doing each 189 things one time. No, when you do it, you record it and then you sign it and your resident director signs it and you're asked the question do you feel you could go in the room and do the next one all by yourself? And if you say yes, then you check, yes, then your instructor, your director, signs it and he's asked this can this resident go in the room and do the next one all by himself? And if one of you says no, well you know what? Then you do it again. And we want a volume of work. I don't want to see like just the lateral windows. It's not that you do one lateral window when you're done. No, no, no. I want you to do at least five lateral windows with no tears of the shinerium membrane, but I want at least five, five shinerium membranes torn also Now. I don't want you tearing them eventually, don't?

Dr. James Rutkowski :

get me wrong. But if you say I've done 15 and you ever have a tear. No, well then, I can't sign you off you haven't done it Because. I don't know if you know how to manage a tear.

Dr. Tyler Tolbert:

And it's not that you've got to manage one tear, no you've got to do this five times.

Dr. Soren Paape:

You say, oh, oh, you know I did this and it worked, and now I know how to do it. I'm not gonna panic, I'm not gonna freeze. When it does happen, you know, you know I'll say too, something that's super beneficial, that, um, I feel like a lot of people don't realize when they go to the ce programs, um, and, and you know, not not like ripping on ce either, like Like CE is great right.

Dr. Soren Paape:

Like excellent. But once you go like, let's say, you do a full arch course A lot of these courses don't do the prosthetic side of things and again you can place a couple implants and four implants on the top and then all of a sudden you go to put your prosthetic in and if you don't angle those implants correctly, you can end up with the patient for the rest of their life ends up with this prosthetic. That's super thick, right, they went in to get something that was like something close to their natural teeth and if you don't place those implants, you don't angle them correctly, you don't know how to angle your multi-units, you can end up with the prosthetic that's not favorable for the patient. So being able to see that, see how to manage the prosthetic side as well, is insane, super, super powerful. And that's what will put you apart from other dentists when you come out.

Dr. Soren Paape:

You know, when I sell treatment to my patients, I get patients that ask me a lot about you know they'll come from a general office, a GP office, where they were just going to refer them out to the oral surgeon, and then come back to the office to get it restored and I let them know like, hey, you know that's that is a good way to do it, and I'm and I'm sure the oral surgeon will place the implants correctly and I'm sure the general dentist can restore it well. But what separates our clinics from from those clinics is I'm the one restoring those cases. So I want to ensure that my implant placement is perfect. That way the prosthetic's nice and thin. So I'm happy, you're happy, and I don't have to deal with a frustrated patient after the fact. Right.

Dr. Tyler Tolbert:

And another shortcoming of continuing education too is you'd be very hard-pressed to make a course. You can make a course about managing complications, but it's not going to be a live patient course. How do you crowd a weekend course with complications of patients Like, oh, you're having a complication right now, well, that's great, we have a course happening in a month. Just hang on for a bit. We've got to run some people through and they're going to manage this complication. No, courses are like that. But in you know, a residency situation you can do that and it's important to be able to actually live manage those complications.

Dr. Tyler Tolbert:

And you know, I was doing an interview with Jason Auerbach.

Dr. Tyler Tolbert:

He's a bloody tooth guy on Instagram and he said, you know and he's an oral surgeon but he's very liberal with you know, general dentists doing surgical procedures, so long as they know how to manage the complications, says you know, as long as you can do anything you want, so long as you know what to do when something goes wrong.

Dr. Tyler Tolbert:

And you know the issue with that is you know, if you've just been doing continuing education, how many times have you actually seen something go wrong? You've probably only seen it go right and you're going to have to run into it in the wild without that support and, just you know, shoot from the hip and uh, that's just kind of the reality of it. It's like you're not going to see these things go wrong until you're doing them. But in this situation you're getting the best of both worlds. It's happening, uh, in private practice, but you still have that angel on your shoulder that's looking over, that's going to be able to take care of you when you don't know what to do. Um, and so to thank both of you, because we've been talking here for roughly 50 minutes.

Dr. James Rutkowski :

And not once have we talked about implant dentistry being a specialty. What we've talked about for 50 minutes is making the best educated implant dentist that we can get Right, and I think that means more to a patient than whether you have a CODA recognized specialty from the ADA.

Dr. Tyler Tolbert:

Oh, you bet.

Dr. James Rutkowski :

But that doesn't mean anything to the patient, the only thing that patient wants is is this a highly educated, highly skilled? And has this doctor who's going to be doing my treatment have? They seen it all yep, you know, and that's the good, the bad and the ugly, because I don't want the bad and the ugly, I want them to know and that's what you, the three of us, have been talking about right for 50 minutes. It's just taking the best educated implant dentist because the three of us have been in the field.

Dr. James Rutkowski :

Oh yeah, past and current you're. You're fighting the fire right now. Every day, you see what happens if it's not done right.

Dr. Soren Paape:

Yeah, oh yeah, it's you know, tyler and I tyler and I were clinical directors for a large amount of dental offices uh, that focused on implant dental treatments. And I can tell you the number one thing that kind of drove people out of doing like we had a lot of doctors that would come in. You know they thought they had what it took to do this and then the second, they ran into some more difficult complications. That's really what it could push them out of the field completely. The implant field and being able, you know, it takes a special person to kind of do it on their own and manage those complications on their own. And that's kind of what Tyler and I have done.

Dr. Soren Paape:

But I'll tell you, tyler and I had plenty of conversations early in our career. Like man, I don't know if, like like you know some of these things, they're difficult to deal with and being able to kind of like slowly work your way up and manage one complication after another slowly, it will put you so much further in the field because you know, one bad complication it can really mess with you know, your anxiety levels when doing these procedures. It can really mess with your anxiety levels when doing these procedures and being able to have someone there for you. It helps out a lot when dealing with some of these major complications.

Dr. James Rutkowski :

Several of our EPAs are managing a particular complication surgical complications or preventing those complications as well and prosthetic complications. So that is, a big part of our EPA's is just complication management and another portion is preventing those complications. That's what it's all about. I want our graduates to come out and I wanted to be successful. I want to be able to sleep at night. I wanted to be able to enjoy their families. I don't want them to go to their kids soccer game and not be there. I mean, they might be physically there, but mentally they're worried about that patient who's got that open suture line and what am I going to do now?

Dr. James Rutkowski :

And all that titanium mesh is exposed and it's just one week post-op. What you know? What? What am I going to? You know, I want our people to be able to prevent that and if they do get it, how they go ahead and manage it. And then they have a network, because all our residents, they get to know each other, they bond together. And so I tell them you know what, these individuals, that you are in this residency program with these 26 other people, they are going to be your colleagues, that you're going to rely on for the rest of your life and I tell them when you have a good day, I want you to be able to call up any one of those 26 people and you will not be perceived as bragging, but they will be happy for you because you had a good day. But also, if you have a bad day, you can call them up and say, hey, have you ever had this? How do you manage it? And, um, as well, as all of our faculty as well, they're all very approachable.

Dr. Tyler Tolbert:

Yeah, yeah, no, that's fantastic.

Dr. Tyler Tolbert:

And I think culture in the residency um space is is super important.

Dr. Tyler Tolbert:

And you find, uh, there are a lot of programs and I know people that have dropped out of programs because of that issue where they felt like it was this very overbearing thing and perfection was expected and there wasn't a whole lot of humility and they didn't get that sort of sense of community out of it.

Dr. Tyler Tolbert:

It just be two or three residents and they didn't really feel safe coming to uh, the residency directors or the chief, uh resident, whoever they may be about some complication they're having. And you know something we we talk about a lot, not necessarily in the context of residencies, but just in our experience working with other doctors that we've trained or been trained by is you don't want to work in a silo in this when you have that kind of bad day. You want to be able to commiserate and get advice from someone else who's run into this before. You don't want to be running into issues that you don't have an answer for at all or can't find an answer for, and having that kind of community and being able to foster that community in the context of a residency is an accomplishment that you know can't really be understated or overstated, I agree.

Dr. James Rutkowski :

I agree 100%.