From Dental Grad to Zygo Specialist: Dr. Drew Phillips' Journey: Part 1

What happens when a determined dental student ignores early academic struggles to become an expert in full arch dentistry? Meet Dr. Drew Phillips, our guest with an extraordinary journey through the dental world beginning from his roots in the Dental College of Georgia. In this episode of the Fixed Podcast, Dr. Phillips takes us through his transition from aspiring surgeon to a leading figure in implant dentistry, sharing how the influence of his father's medical career and a remarkable performance on the dental admissions test paved his path. 

Join us as I recount my own experiences in a General Practice Residency, highlighting the intense pressures of performing under professional scrutiny and the critical lessons learned about surgical visibility. From Salt Lake City's sedation dentistry to the complex world of advanced implant cases, our discussion uncovers the thrilling, yet challenging, leap from residency to specialized surgical fields. With anecdotes of managing unexpected complications, like being left to tackle a double arch case solo, the episode emphasizes the importance of understanding prosthetic aspects before advancing in implant surgery.

Together with Dr. Phillips, we explore the intricate decision-making process in implant placement, discussing the nuances of sinus positioning, implant types, and the strategic use of cantilevers. Listen in to discover our favorite dental instruments and the invaluable insights gained from international courses with experts worldwide, including a memorable training experience in Brazil. This episode promises an enlightening look into the dynamic and rewarding world of implant dentistry, offering both seasoned professionals and aspiring dentists a glimpse into the complexities and satisfactions of the field.

Chapters

• 0:40 Implant Dentistry
• 12:18 Post-Residency Career Beginnings and CE
• 24:29 Collaborative Zygo and Pterygoid Implant Cases
• 34:58 Implant Placement Strategy and Techniques
• 38:33 Dental Instrument Preferences and Training Locations

Transcript

Dr. Tyler Tolbert: 0:40

My name is Dr Tyler Tolbert and I'm Dr Soren Poppy, and you're listening to the Fix Podcast, your source for all things implant dentistry. Hello and welcome back to the Fix Podcast. So you may notice that we are missing someone today. So Dr Poppy is off on his first vacation in like two or three years down the DR with his beautiful girlfriend and spend some time down there, and I'm back here recording podcasts. But I'm actually having a really good time, and today I have a special guest with us, dr Drew Phillips. So he and I actually have some similar beginnings. So we both graduated from the Dental College of Georgia. We're some down south Georgia boys that have come out to a different part of the country to do a whole bunch of full arch, and so Dr Phillips here has done, has an incredible body of work. If you're unfamiliar with his work, it's pretty impressive. I suggest you find him on Instagram. He is a fully remote Anchorage capable full arch doctor and he hasn't been out much longer than I have.

Dr. Tyler Tolbert: 1:50

What year did you graduate, drew? I graduated 2019. Yeah, so not much further uh along the me at all, but uh, so much further clinically. Um. So I've been so impressed with everything you've been able to do. And, uh, I've been anxious to hear about your clinical progression and how you got into doing what you've been doing for some time and, uh, what better way to do it than you know live on the show? So I really appreciate you taking some time out and I'm anxious to get it going. Yeah, for sure, awesome, awesome. So for those that don't know you, could you just kind of give us some description of you know, your background, your general story, how you got to where you are? Just the overarching view.

Dr. Drew Phillips: 2:19

Yeah, so it's funny, I'm actually from georgia originally. I uh, I kind of grew up only knowing anything medical. My father is a radiologist and I grew up wanting to be, you know, some sort of surgeon. You know, originally it was an orthopedic surgeon and, um, you know, I had the opportunity to shadow, you know, basically every surgery there is in the hospital, but anything from like total hip replacements to just simple stuff. And the thing that they all had in common is that they told me, if they were to do it again, they would be a dermatologist or a dentist. I heard that a lot and I was like, oh, okay, well, you know, dermatology sounds terrible and you know, my, my father, being a physician, is like dermatology is terrible. Don't do it. I mean, yeah, it's good money, you want to be a pimple popper.

Dr. Drew Phillips: 3:07

Yeah, I mean, it's, it's, it's it's one of those things where it's like you know the diagnosis 99 of the time before you even walk into the room. So it's like, yeah, they make good money, but like, yeah, it's, I want something more challenging and and something you know, you know, I think that would be more fun. So I started looking into dentistry and, and you know, really enjoyed it. And, uh, my sister as well. My sister graduated dental school two years before me. Okay, so, uh, she's a pediatric dentist. Uh, here in Boise as well. Um, so I went to college in Florida and then ended up going to dental school, you know, in Augusta. Um, what a wonderful place Augusta is.

Dr. Drew Phillips: 3:47

One one week, one week a year, um, uh, yeah, it's like everyone, everyone's like oh man, augusta, that must be such a cool place. And I'm like, yeah, one one week a year, it's really cool. The other 51 weeks it's like the city spends like the two weeks before the master is cleaning it up, making it like a really nice place, and then, yeah, the day is over, man, it's all done.

Dr. Tyler Tolbert: 4:10

Back to Augusta and I never really spent much time during that period because I would always just like rent out my condo or whatever and then I'd skip town. So I never even really saw it during that you know golden, you know moment. I saw it for what it really was, but uh, but, you know. You know what that's.

Dr. Drew Phillips: 4:26

That's the crucible that we both went through, and here we are, so I'm appreciative of it you know it's funny, my one of my classmates, he, his house was close to the national and one year he just with dental school. He just like hadn't cut his grass. And they came over and was like, hey man, can we cut your grass? That?

Dr. Tyler Tolbert: 4:43

That's great, you just hold it out. It's just like, yeah, let them take care of it.

Dr. Drew Phillips: 4:46

You know they have a vision. They want people to think. But it's great. I go back every year for the master's. It's a good time, so yeah, so I went to dental school, dental College of Georgia, medical College of Georgia, georgia Regents whatever you want to call it, depending on who you ask. Um, you know, dental school was was dental school. I uh, it was funny. I never made straight a's until I went to dental school oh, really, yeah, I was never a great student.

Dr. Drew Phillips: 5:16

Um, you know, I think in college I had. I mean, I had a great time in college, but I think my science gpa was like a 3.2 and standard GPA was like maybe a 3.6, which, compared to, like, my dental school classmates, was like not anywhere near theirs, yeah, but I killed the DAT. It was like I studied for that thing, like it was a job. It was like six days a week, 10 hour days. It was funny. Like two weeks before the dat, like I I realized like how to take the test. Um, like everything finally clicked and I was like, oh wow, I don't really need to know this information, I just need to know what the wrong answers are going to be. And then I just, yeah, extra right answers, like it's just like a game and um, it's fine. I've actually helped a lot of people at the dat since.

Dr. Drew Phillips: 6:04

Um and yeah, so I did really well in the dat and um, nice and uh, yeah, so I got into dental school, which I, you know it was like my dad was like hey, drew, like you know you should look at some other options. Um, just kind of like you know, I'd never. It was one of those things you know it's like, but you know I got really lucky and got in dental school and, um, you know, made the first I think it was like the first test like a biochem test made and made it like a 93. On that I was like, oh shit, like maybe I can do this thing because, like, I'll admit, like I went to dental school like my sister you know she had she'd been a straight A her whole life and made one B her first semester of dental school. So it's like well shoot.

Dr. Tyler Tolbert: 6:47

If she didn't do it, reality just came crashing down on her.

Dr. Drew Phillips: 6:50

Yeah, it's like there's no way I'm going to make straight A's. I was like I go through dental school, like when I get in, like my whole mentality is like C's get degrees, like let's just get out dental school. Um, but uh, but yeah, I ended up doing really well and, um, you know, I worked my ass off in dental school and um, so I ended up graduating and I was valedictorian in my class, um, so you know, everyone was like so I ended up going to a GPR. After that I went to the VA hospital in Salt Lake city. Uh, you know I I had a. You know I I ranked that number one. Um, you know I had a. You know I I ranked that number one.

Dr. Tyler Tolbert: 7:27

Um, you know, there's some other great programs. I was looking at what, uh, what attracted you?

Dr. Drew Phillips: 7:29

to that one. So you know, there there's a few things. So the other one I was really interested in was the uh foundry in alabama. Um, you know, the va and san antonio had a really good A few others had really good reputations.

Dr. Drew Phillips: 7:45

The one thing I really liked about Salt Lake City was number one was location. I grew up, you know, we grew up skiing. We were not like a beach family, we were a ski family. So we were always out in Utah skiing and that was a big drive for me, kind of, I guess, jumping right into, like, my residency after dental school was the thing I loved about the VA in general was the fact that patients didn't have to pay for treatment.

Dr. Drew Phillips: 8:11

So you know, it's good and bad, right, like I never learned how to sell treatment and how to sell my treatment plans, but I learned how to basically do everything and that the VA in Salt Lake City specifically you, you know we had a different specialist pretty much every day of the week. So you know it was like monday we had endo. Like every monday afternoon we were doing molar endo. Every monday morning we were doing, oh, wow, you know we had an oral surgeon. Um, you know we had a day with. Thursday was perio, thursday was pros, some tuesdays, I think, we had an oral surgeon. Then on top of that we had, you know, a handful of really good GP attending.

Dr. Drew Phillips: 8:48

So you know, we really got our hands in in every sort of specialty and learning from those specialists, as well as running from the GPs there which were doing a lot of the same thing. Um, so you know, I'm really thankful for my, my gpr. I think it gave me a little bit of a of a head start. Um, it was cut short with covid, though covid hit. I think it was like march of that year and I remember I was one of the first hundred and people in utah to get covid. I was like there's the state, I was like the state's like specimen they were calling me like multiple times a day and I'm like guys like I'm.

Dr. Drew Phillips: 9:22

They were calling me like multiple times a day and I'm like guys like I'm fine.

Dr. Tyler Tolbert: 9:27

You got to lead the pack. That's just your, that's your whole personality. You gotta. Yeah, it's just like I'm fine.

Dr. Drew Phillips: 9:32

Guys, like it's not a big deal, uh, I'm just chilling in my house, uber and getting uber eats and um, wow. But but you know, I think the one thing that my gpr probably taught me the most was how to do dentures. I mean, we did a ton of dentures in my GPR. You know we were doing full mouth extractions. You know we didn't do any full arch in my GPR. Our standard of care was two implants you mandibles for snap denture, complete upper denture, and. But it taught me a lot because dentures, I think, are like the basic basis for everything and I see so many people, you know I get hit up on instagram pretty frequently with people being like hey man, like how do I, how do I learn how to do this and things like that. And I'm always like go learn dentures. You know, go work at affordable dentures or something like that.

Dr. Drew Phillips: 10:29

And just like do dentures a year, yeah, yeah, because I mean you can. You could tell me like, hey, man, I want to do veneers, I want to be like Dr Appa. I'm like, okay, go learn dentures, because it all starts with where you put in your incisal edge and the bite. Dentures is the basis. And, man, we hated dentures in dental school. Everyone hated them. Oh yeah, frigging. I mean Metzler still. You know what's funny about Metzler, actually, and I hope he actually listens to this, or before no way before he was at georgia.

Dr. Drew Phillips: 11:07

Um, I didn't know that. Yeah, I remember seeing patients and I'd like scroll back, you know, because they're trying to be like what's done? It's like kurt metzler. I was like, oh shit, what's up man he's a man.

Dr. Tyler Tolbert: 11:17

Yeah, I still. You know it's funny in retrospect. You look back on those guys and you're like you know what. You made some core memories for me that you know. Some of it's bittersweet, but you know what it's a memory seriously. I could still hear thunderstruck for every rpd, uh, practical that I did yeah, I can't say I did any parcels after dental school but um but, yeah, I mean.

Dr. Drew Phillips: 11:36

So, you know, learning dentures, I think is just an invaluable, an invaluable thing, and and also the other thing it teaches you which I think is invaluable, is like patient management. You know totally, how do you speak to patients, how do you set expectations for these type of patients? Um, so, yeah, so my gpr I did you know about a hundred implants, I think, a few immediates, that's fantastic um, those are mostly in the context of an overdenture uh, we did quite a bit of single implants.

Dr. Drew Phillips: 12:07

Okay, um, we did. You know, I did a lot of sinus grafting, really not much like direct sinus grafting, a lot of lateral sinus grafts. Um, I still remember my first one. I uh my attending lane brown. He, he did once the person needed bilateral and he did one side and I was meant to do the other side and like, right when I was starting, we had a whole bunch of people show up that were like interviewing or visiting for the GPR and I'm sitting there with like four people over my shoulder laying Dr Brown. He had already left the room. He like went to go do something else. He's like ah, you got it, man, and you know I'm like trying to do this thing. I got all these people over my shoulder and they're like and you know I'm like trying to do this thing, I got all these people over my shoulder and they're like I dude, I have no idea what I'm doing, and they were like it turned out good, but you know, so we did a lot of that.

Dr. Drew Phillips: 12:57

Um, the other thing that you know we did was anything we did on the mandible, like you flap down to the mental nerve. So I see a lot of people learning full arch now and they're like everybody wants to make these like little baby flaps. And I'm like you can't see anything, you don't know what you're doing. I mean, I flap and every now and then the drill comes out, the buckle plate or you know an implant, and I'm like, wow, if I didn't have it flapped, I would have never seen that. You know, um, totally. So. You know, I was never scared to make big flaps because we were forced to. I mean, we were that's great. Um, so, yeah. So you know, that was my gpr experience. It was really invaluable for me to work with all these special specialists and, um, you know, do a lot of dentures, even though I didn't like it while I was doing it. I look back on it and I'm like, man, I wish I would have done more of these, or, yeah, it's invaluable.

Dr. Tyler Tolbert: 13:49

Yeah, yeah. So, like at that time when you were going through the GPR, was your mentality that you were going to be like an omni capable GP, or was there like kind of a what was the end in mind?

Dr. Drew Phillips: 14:00

So you know, at a dental school I didn't know what I wanted to do and everyone was like, oh you know, why aren't you going to ortho, or why aren't you going to oral surgery? And you know, ortho was out from day one. To me that just sounds not fun. And you know good for you to be honest, but it's just not for me. So you know, GPR for me was just like that. Next step, you know, out of dental school, I thought that I might like endo.

Dr. Tyler Tolbert: 15:30

And after like two molar endos, I was like I never want to do this ever again. Um, yeah, I was under no illusions.

Dr. Drew Phillips: 15:33

Yeah, when I came, my first root canal, my first root canal out of out of residency was like number 19 and broke broke first file ever broke, first patient out of residency. I was like, wow, I think that was the last root canal I ever did.

Dr. Tyler Tolbert: 15:47

That's great.

Dr. Drew Phillips: 15:48

That's great Um but yeah, man, so it was uh. Yeah, I loved it.

Dr. Tyler Tolbert: 15:56

Yeah, cool. So so you're coming out of GPR and, um, you know you, you have the sobering reality of breaking off a file and a number 19 and you got all these skills with like dentures and surgery and implants. Um, so what was the next step? How did you kind of transition from there? What was the direction that got you kind of in more in the aim of surgery?

Dr. Drew Phillips: 16:14

So I my, you know, my GPR kind of got cut short. You know there was about three to four months where, and so there were, there were some still some things that I wanted to do and learn before I kind of like dove right into whatever I, you know, ended up wanting to do, which I really still didn't know. I still had this idea in my head that I really liked cosmetic dentistry, and that was not something that I got to do at um the GP, at my GPR, cause it's the VA and we do functional we do functional dentistry, not aesthetic dentistry.

Dr. Drew Phillips: 16:46

And so I went to go work at an office, uh, in Salt Lake city, um, where I was doing a lot of sedation dentistry and, um, you know we're doing a lot of. I was doing, you know, probably one to two sedations a day, just whether it was fillings, crowns, implants, things like that, um, um, and I was there about I think five or six months, uh, before I left, um, and I started doing some full arch there. I probably did maybe 20, 20 arches while I was there, um, most of them are all under my own sedation too, which is is I would not.

Dr. Tyler Tolbert: 17:27

I would never do that again, and were you doing your own conversions as well?

Dr. Drew Phillips: 17:36

So there was a. There was like a a quote unquote in-house lab there. So they were kind of doing the conversion. I mean, we were helping, but for the most part they were doing the conversion and then we were restoring. So I think, like, if I were, you know, going back to, I think you know they wanted me to do something like 20, like you know, take like 20 patients to finals or something like that. Before I did my own surgery, which is for sure, the right thing to do is to to learn the prosthetic aspect of it before you start, you know, throwing some implants in. Um, yeah, I remember my first case still, it was uh, uh, it was a double arch. The owner of the office was supposed to come there and like basically hold my hand through it and 20 minutes before I called him and I was like yo, man, where you at?

Dr. Drew Phillips: 18:19

and he's like oh you got it, but he's like I'm not gonna make it.

Dr. Tyler Tolbert: 18:21

And I was like and then, and then, four people came into the clinic to watch you do it right? This is what happens thankfully.

Dr. Drew Phillips: 18:28

thankfully they had assistants there that had done enough of them Like they could probably do it themselves. But, yeah, my first double arch took me pretty much exactly four hours. I still remember it, it's actually not bad.

Dr. Tyler Tolbert: 18:40

It's not bad at all.

Dr. Drew Phillips: 18:40

Yeah, I was super proud of myself.

Dr. Tyler Tolbert: 18:42

Yeah.

Dr. Drew Phillips: 18:44

And I think it healed. Well, I don't, you know, I don't really know. Um, yeah, so I was there and then I uh, I was I wanted to get out of there pretty quickly and was just looking at some different options. And that's kind of when I was, I was like, okay, do I want to go somewhere where there's like a lot of more of like aesthetic dentistry so I was looking at an office and working at an office in park city or do I just want to go completely something different? Because this was really my first.

Dr. Drew Phillips: 19:11

This office I was working on salt lake city was really my first like um experience to full arch and I liked it. You know what they were paying me to do. It was not worth my time, like I could have just been prepping crowns and I would have made more money, but I liked it. I wanted to kind of see where it went. The office I was looking on park city just really kind of didn't work out, um. So I went to california and was working at an office there that had another in-house lab that was doing a lot of um, like kind of a lot of digital workflow stuff and, oh cool, okay, so I was there.

Dr. Tyler Tolbert: 19:46

This would was this like 2020, 2021 it was like 20 see graduate 2019.

Dr. Drew Phillips: 19:52

So this would have been like I think it was like december. I started like december of 2021. Okay, 20, yeah, 2021, um okay, and I, you know I did. I did quite a few surgeries there. I did a ton of sedation, but the the aspect of them having an in-house lab was was huge for me and becoming friends with the lab tech there. It's a guy I'm still friends with. He's actually out on his own. It's AOX Designs, joseph Rodriguez. He's the man. Him and I are still buddies. We still, you know, talk about cases together. Him and I are still buddies. We still talk about cases together. Him and I created some protocols together. So just learning the digital workflow there was huge.

Dr. Tyler Tolbert: 20:39

Is that with Gus Khalil?

Dr. Drew Phillips: 20:42

No, it was in my AOX, is it? What is his name? No, it's not with Gus. That's actually where I met gus, though oh okay, okay what is his name? Joseph rodriguez, okay, um, whatever, but uh, yeah, he was the man, um, and that's where, kind of like, my ce journey started and that's where I became addicted to ce, um, and so I, uh, I took a lot of ce courses that year, um, and that was like my first kind of remote anchorage ce course as well nice, nice.

Dr. Tyler Tolbert: 21:26

So you were actually doing the fixed arches prior to really taking the ce courses. It was more just you know experience in residency and then whatever was happening in that first place that you went to, that kind of you know, yeah.

Dr. Drew Phillips: 21:37

So it was kind of like a c1 do one teach one sort of thing. Got it right like I. I watched a bunch, I restored a bunch and you know I had the basics right. Like I was fine laying a flap, which again is something that like conceptually seems really easy to do. But you watch people that are new at her. I go and like mentor people and I'm like man, that flap's got to be way bigger.

Dr. Tyler Tolbert: 22:01

I mean like yeah, look at we're doing thickness and you can't see anything.

Dr. Drew Phillips: 22:05

There's blood everywhere yeah, I'm all over the place, yeah you know the basics, I I had the basics of pretty much everything. I was comfortable around the sinus, I was comfortable around the nerve, and so you just kind of have to put it all together and, uh, so yeah, so that's where I started my ce journey. Um cool, and you know, that was, I guess, my first ce, like remote, remote anchorage as well well, wow, wow, yeah.

Dr. Tyler Tolbert: 22:29

So you kind of like we're already kind of going straight to, uh, to some of the more advanced techniques, like right off the bat with your, with your CE. Yeah, that's cool.

Dr. Drew Phillips: 22:37

Yeah, yeah, it was. Uh, you know, after that I kind of, I guess maybe I took some steps backwards. But you know, remote Anchorage is not something I ever wanted to do and the first course I took was a live patient course with uh, fishy broman um in his office in arizona. And I remember, yeah, I was already, I had already become friends with him and he was doing a course and I was like, man, do I really need to learn this? Like this is so out of my league. You know there's no like, like and he's like man, you're young, you're, you're gonna be, you know, you going to see your own cases fail. I'm like that's the scariest thing to think about. He's like, you know, you should at least learn how to do it, whether you do it or not. And you know I probably took that course too early and I don't think I did any zygos, I probably did a handful of pterygoids, no-transcript okay, yeah, that's.

Dr. Drew Phillips: 23:37

That's a really big gap yeah, I did the time you learned, at the time you implement. Yeah, I did two in one day. It was a husband wife, they were, uh, it was did you know that they were going to be zygos before you started or was it like a necessity?

Dr. Drew Phillips: 23:51

okay, yeah, so a little story with that. They so my parents were still living in georgia and we'd had this, um, the lady that cleaned our house she'd been, you know, she'd she took care of our dogs. I mean, she'd been there when I was a small child and cool, um, we I don't think anyone my family ever realized they had, like teeth problems and I guess they like saw what I was doing and instagram or whatever, and and went to my parents and was like, hey, like you know, we went to clear choice and we got these.

Dr. Drew Phillips: 24:22

Uh, yeah, you know, it was like back then clear choice was charging probably like 60 000 plus dollars you know something crazy like that.

Dr. Drew Phillips: 24:29

And I was like, well, you know, like go get a ct. You know, clear choice wasn't gonna share the ct. I was like go get a ct somewhere and and uh, send it to me. And I immediately saw it and I was like clearjoy said they could do standard all on four in this. There's no way, like both of you guys are zygos like 100. And I was like, well, you know, I took a zygo course, I'll you know, they're nice people some time ago.

Dr. Drew Phillips: 24:56

Yeah, these people are nice um, yeah, cool, you know, like they've helped us, like, so I did them for free and we did them both in the same day. Um and uh, we did did them at a friend's office in oregon. Um and uh, from what I know, every they're, you know they're still good. I mean, they see my friend's office in atlanta for cleanings now. Yeah, so that was my first zygote patient was husband and wife.

Dr. Tyler Tolbert: 25:25

Wow, that's awesome. So were those were like, um, uh like, was it like a quad zygote or are you doing like a single on one side, or?

Dr. Drew Phillips: 25:35

Yeah, so they were both just uh, post-year zygotes. And and you know, look, I didn't even do pterygoids on that case because I mean that took me so freaking long and I was like I was just like I just so they. You know, I've got posterior zygos on both, just two implants on the anterior for both of them. Both of them got four implants in the lower. You know, one of these days, uh, you know, they'll probably come visit me in in idaho, um, or in oregon, wherever I'm working somewhere, and you know I might go and add some pterygoids to them because I want them to last for the rest of their life. Yeah, ideally. But yeah, you know, I haven't, I haven't even looked at, like the post-op CBTs, cbcts. I'm sure the, the Zagos are right in the middle of the bone, you know right where they should be, but you split the field goal.

Dr. Tyler Tolbert: 26:21

That's great yeah.

Dr. Drew Phillips: 26:24

Got to start somewhere, I guess. Yeah, no, of course.

Dr. Tyler Tolbert: 26:26

Yeah, no, I mean props to you for just kind of going in head first with that. I mean, you know, a lot of people will take, you know, three or four courses. I want to do a few cadaver courses, some live surgery, and then still want to do some over the shoulder, which there's merit to that, of course. But at the same time, I've noticed that a lot of the people that you know end up teaching these things, um, they can kind of be a little bit of cowboys, you know, if you will, maybe that's kind of a derogative term, but, um, you know, people that are willing to, you know, feel confident in their abilities as soon as they, you know, understand the full scope of it and understand that you're not really going to know how to do it until you do it, um and as, and I think that kind of, uh, that kind of service for a patient that otherwise wouldn't really be able to, uh, to get something, it would be a standard of care.

Dr. Tyler Tolbert: 27:10

I mean, if there's a Zygo patient, why would they get you know, standard all in four? So, um, yeah, that that was a lot more of these cases, or how did? How'd you feel about it?

Dr. Drew Phillips: 27:19

You know, not, no, um, really, you know, I still like every time I see a Zygo case, I'm not like oh man, I can't wait through this. I'm like ah, really Like that's a good attitude, actually.

Dr. Tyler Tolbert: 27:31

Um, that's how it should be.

Dr. Drew Phillips: 27:33

I mean like I can do them and and you know I will do them, but it's not something that I like go strive to do and like really enjoy because it's it's exhausting, it's high risk. I mean it's high risk for anyone. There's GP, perio, oral surgeon, it doesn't matter who's doing it. Um, and you know, thankfully I've not had any zygos fail. I haven't had any huge issues from from zygopatients. I mean, honestly, my, my worst complication on a patient I've had is on a lower arch where the guy had the only teeth I had to take out was both canines. The only thing I left and I was like the worst complicate. It was just like a total massive infection, just hospitalized, like it was just like a total disaster that you know I'm like man, what, what could I have done differently? And I feel like I did everything right and he's got Zygos on the upper.

Dr. Tyler Tolbert: 28:26

I was like really, Like it was, like it was two years ago.

Dr. Drew Phillips: 28:30

It was the hardest Zygo case I ever did, like I drilled once, couldn't get torque. Drilled again, placed. Couldn't get torque third time on this on, like it was on camera. Well, drilled, again placed. Couldn't get torque Third time on this, like it was I can't remember what left or right side it was like finally got torque. I'm like man, this is the hardest Zygo case I've ever done.

Dr. Tyler Tolbert: 28:48

And I get a complication on the lower. Yeah, the irony it's always the ones you don't see coming. I've definitely found that the ones that I worry about tend to work out and then the ones I wasn't worried about just totally disregarded. Those are the sneaky ones, oh yeah.

Dr. Drew Phillips: 29:00

The cases where you load it, it's like 180 centimeters composite torque value and it's like everyone just go home and say your prayers and they heal a mate. No problem, no problem whatsoever.

Dr. Tyler Tolbert: 29:13

Yeah, yeah, no, I totally get that. Okay, so you placed your first Zygos about eight months after that, first course still not feeling entirely psyched about them. What kind of made you want to go a little bit further down the road of of doing more fixed for large and atrophic cases?

Dr. Drew Phillips: 29:28

so I started. This is when I started traveling to oregon a lot. Um, so I'd moved to boise. At that point I was, uh, working at an office here covering for a friend's maternity leave. Um, okay, I was doing that, was traveling to a couple different offices in oregon and you know we didn't stock zygos and we started just getting some cases and, um, I was like, well, I'm kind of forced to do these now. Um so, so, yeah, so I just started doing them and you know I hadn't taken any other course yet. I remember I went this was years ago now I went to a trans nasal course in Boston. It was just like a one day course. It was like David Zellig and Simon oh.

Dr. Tyler Tolbert: 30:15

I was teaching it and uh and it was.

Dr. Drew Phillips: 30:19

It was a transnasal course. They talked a little bit about zygos, but it was my first time meeting, you know, like david zellig and simon, oh, um, a lot of the other guys I'd already met before, just through different courses or whatever, and um, I can't remember if one, if one gonzalez, was there or not, but anyway, like you know, again, like that course, like a few weeks later I did a trans trans nasal. Um, nice, that's been, I think december was two years. Still have not seen that patient for post-op.

Dr. Tyler Tolbert: 30:48

But you know. I mean it's fair to assume that things worked out.

Dr. Drew Phillips: 30:53

Yeah, as far as I know they look great but great. So you know I'd probably done I don't know or so Zygo cases, very few quads, maybe a couple quads. I mean even still like I've only done a couple quads. And so then I loaded up a case. I loaded up three Zygo cases one day and I had Juan come do those cases with me in Oregon at the office. I was at there. So Juan came and we did three upper arches in one day. So Juan came and we did three upper arches in one day.

Dr. Drew Phillips: 31:21

You know, I think a couple transnasal, a couple zygote, and it was great. I mean it was. You know, anytime you do something with any other doctor, like they're learning from you, you're learning from them. You know I was learning some zygote stuff from him. I was showing him how I was doing my pterygoids, because I was placing my pterygoids with just standard neoden implants and had, like you know, upper 90 success rate of of every time I placed it. And you know I wasn't using the Norris that you know, arguably was a better designed pterygoid implant, but I was having great success with just the neoden, like 3.75 by 18 helix, and had great success with it.

Dr. Drew Phillips: 31:59

And, uh, you know know. So I showed him kind of like what I was doing with that. I was using some osteotomes from salvin, I was using some osteotomes from norris, just kind of figuring out what worked for me and, um, you know, so it was cool, just kind of collaborating with him on that and learning. You know, each of us learning from each other and uh.

Dr. Tyler Tolbert: 32:19

So are you kind of like a, are you a drill osteotome hybrid type of guy, is it?

Dr. Drew Phillips: 32:23

I mean, I keep changing my ways of things. Um, you know, so I I love the Norris, uh, the like the 2.0 sharp osteotome, which I think, uh, I think the SIN one is almost identical to that. Now, Um, you can also get it from like GDT for like 90 bucks as well, and so I at least just try to push with that till I can feel something hard. Sometimes it's hard already, and you know, when I have that I'm like great, like almost doesn't matter what I do now, like we're going to get to work.

Dr. Drew Phillips: 32:55

We're good to go. So I'll push with that until I feel something hard and then I will just take like a standard spade drill and go really slow and just feel until I, you know, I perforate the plate and if something doesn't feel right at that point I can kind of redirect, redirect, right, um, and then I have a I believe it's 2.7 millimeter osseotome from salvin that I got. Uh, my my friend, uh, shivane gupta is an oral surgeon in atlanta told me about that, so I bought it back now and, uh, so I got that and you know basically that if I can get that down to like 12 to 14 millimeters, like I go straight to placing the implant. If, if it won't go in, then I'll pick up a 3.5 drill and go a little bit more.

Dr. Drew Phillips: 33:41

But you know what's awesome about that neodym helix is, you know you open up, you know a cortical plate with the two millimeter drill, like you can almost guarantee yourself that it's going to grab and go in there. Yeah, yeah, you know, every now and then it would. You know an implant would hit it and it would spin, and pretty simple, just pick up the 3.5 drill and just, you know, I leave it on like the 40 newton centimeter or 40, I mean uh rpm speed and just barely open it where you can kind of feel every turn and just cutting just to open it up enough, and I see, um, and yeah, I mean, as long as I'm in the right spot, like my success rate is is really high with my pterygoids.

Dr. Tyler Tolbert: 34:20

Great, yeah, fantastic, okay, awesome. So that's the. So that's your pterygoid. You know general routine there. So anything special would you say about your zygotechnique? I mean, would you say that's kind of like a you know? I guess the way I should put it is what kind of school of thought do you generally have in terms of your approaches?

Dr. Drew Phillips: 34:40

I go to surgical approach with it. So I have kind of like, uh, you know, I guess, jumping off of CE and we can go back to see if you want some other ones. But like my general approach, like I guess, like kind of in my head, like my algorithm of like how I'm going to approach each case, kind of like jumping into like Patsy protocol, if you will. So for me it all comes down to like where the sinuses are Right and so that you know, like where the sinuses are, does it dictates, like where my you know where my teraglute implant starts. It dictates, you know, am I going to do a Zygo? It dictates like how my front four implants are going to be.

Dr. Drew Phillips: 35:17

So you know, my train of thought is, if I can get you know, first of all, we don't want cantilevers, if at all possible, right. So if I can get an implant at first premolar and a pterygoid, I don't need a Zygo. I feel like that spread is fine. Um, you know, if I can get one at second premolar, great. And you can argue that on those cases, a one-tooth cantilever for a molar is okay. I mean, you know, we don't like, we don't like cantilevers.

Dr. Drew Phillips: 35:45

However, clear choice has been doing that for forever, oh, that's the vast majority of cases um you know, and and I have cherry boys under my belt so, yeah, I do them for most cases now. But you know, look at what clear choice has done. I mean, they've done more than anyone else and like their standard of care is just four implants giving them a one tooth cantilever. And you know the people I know that have been there for a long time so they have great success with that. Um, so yeah, so my, my kind of algorithm is like, if I can get like first premolar and a pterygoid, I don't need a Zygo. If I can get, you know, first premolar and I don't get a pterygoid, you know I need as I go.

Dr. Drew Phillips: 36:21

Um, you know, anterior is whatever. Um, you know, there are some cases now where it's like I've done things you know where I would need a quad and I've done you know whether it's like transnasal implants. I have one case again all these cool cases I've done, people refuse to come back for post-ops. So I have a case where I had, uh, I mean, I had like, I think like six millimeters maybe it was like five, like you know, under the nose, and I did pterygoids, uh, two like first molar zygos, and then I placed three helix short right in the anterior and it was all cortical bone.

Dr. Drew Phillips: 36:58

So it wasn't like your standard. I's cortical bone. I'm like this bone's not going to talk to dr molinari about it and he's like, yeah, that's a great idea. So I placed, you know, two like in about the lateral spot and one in the nasal palatine just those new those, my first helix short implants I placed and got great torque. It was all cortical bone again. I probably did that. I was like, right after the helix Short came out Again, still haven't seen that patient pack. It's like all the cool stuff, I don't see anything.

Dr. Drew Phillips: 37:24

Yeah, that's brilliant, awesome, awesome difference and you know, doing a half-ass flap or just being able to see everything. Um, you know the one thing, when it came to my flap that you know I learned from. So I I took a um alex avonis course in uh in brazil with um dan rosen and dennis smiler. It was funny. I again, I was never planning on taking that course and I had a buddy perry donis was going to go and I was like, yeah, man, I'll go with you, and I think he had a family emergency, ended up not being able to go, and so I went. I had a great time.

Dr. Drew Phillips: 38:09

Um, and one thing Alex Savonia is like he was always getting me to flap like more, like posterior on the arch, which like really opens it up a lot more than just trying to like only where the implant goes and uh, so you know, again, like bigger flaps, I don't really use any of like the special uh Zyger retractors. I use a Minnesota. I have a pretty cool Minnesota. I don't know the name of it. Um, it's a Minnesota with more of a handle. Um, there's a. I think they make one that's like an ergo Minnesota. It's not that, it's a little different.

Dr. Tyler Tolbert: 38:45

I've seen this. Yeah, I saw it at Clark Damon's course.

Dr. Drew Phillips: 38:47

I think it's just a longer, it's just a longer Minnesota basically, and I I love that thing. Um, okay, I have like another instrument. Um, salvin makes one. I think they call it like the zaga three. I think nester uh posted about it today. I I got one from like uh h and h instruments, um, just basically the shape of like a molt nine but it's just like three times the size and for me it's really good for this blunt dissection. Just a spoon, um, yeah, it's just like a big spoon and uh, yeah, so you know just different things. And um, you know, the brazil course was great. Uh, brazil is my favorite place I think I've ever been. Um, I love brazil. Yeah, it's great everything about it um.

Dr. Drew Phillips: 39:32

I've been back I think like I've been back. I went back this year for another course too.