Speaker 1: 0:40

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, awesome, awesome. So, like what's so, while we're on the subject of CE, what's kind of on the cutting edge for you right now? Like, what kind of courses are getting you excited?

Speaker 2: 0:58

Man, that's a good question. I feel like I've taken all of them at this point. Uh, I'd like to take some more like perio type courses. Um, you know which I got. We'll probably get into a little bit as like what's like my future looking like.

Speaker 2: 1:11

But you know I I took a uh a year I was living in California. I did take like a a tissue grafting course with uh Dimitri. Um, he's become a good friend of mine. Um, you know, we I did a little tissue grafting in my, in my residency, but nothing like that I would ever remember how to do. Uh, I do a lot of free gingival grafting now.

Speaker 2: 1:35

Um, cool, I think in the last year I've fixed a couple of mine and more of other people's uh like oral antial communications. So just, you know, tissue management is is a huge thing that you know I'd like to learn more about. And you know, like connective tissue grafts, for sure, free general grafts like to me is like it's just whatever, like you just do them. And you know, I think more people should learn how to do it because it's pretty hard to screw up. But I would like to learn some more tissue grafting around teeth, you know, of course, the more like remote anchorage stuff. It doesn't matter how many courses you take. You're going to learn something new from every single person.

Speaker 1: 2:15

Right.

Speaker 2: 2:18

You know, there's just I feel like I'm starting to run out of courses, but it's like as soon as I started thinking that something else pops up. You know, I at one point I dabbled into learning a little bit of design.

Speaker 1: 2:29

Yeah.

Speaker 2: 2:30

Again, that's something that I want to do in the back of my head, but then every time I sit down to do it, I'm like I don't want to do this. This is hard yeah.

Speaker 1: 2:37

This is hard. There's a lot of steps, it's it's immaterial and it's not in my hands.

Speaker 2: 2:40

Yeah, I totally understand that.

Speaker 1: 2:42

Yeah, I took a, I took a course with uh, with uh Wally Renee, over at the uh MOD Institute. Um, just trying to learn how to do like digital uh removable, and I figured that would give me a pretty good you know, understanding of, you know just ExoCAD and how that works. And uh, yeah, I mean I, I, uh, I loved it and I think for on that day I felt confident that I could design like an immediate venture and some partials and stuff. And then right after that I was like, yeah, if you put that software in front of me, I couldn't, I wouldn't know the first thing to do oh yeah, dude, I have an xcat donald.

Speaker 2: 3:12

I couldn't even, I don't even know how to, I don't even know how to open it. It's like, it's like hard just to even open the application I don't think people realize, like designers don't get enough credit, Like their job is incredible. It is so hard to be a good designer and be, you know, good, quick, you know efficient, but again, it's something you know like, while Renee's, like, you know, the modern suit that's. That's on my list of things to do.

Speaker 1: 3:37

I took a great course, by the way. Yeah, yeah, it was fantastic. Oh, for sure, it's me. I'm shitting on.

Speaker 2: 3:42

Yeah, oh, dude, I hear only great things about his courses.

Speaker 1: 3:45

Yeah, no, it's great.

Speaker 2: 3:50

You know I took the first like two COIS courses of kind of the COIS curriculum. I was signed up for another one in March that you know again I signed up for like a year and a half ago. It's like. It's like when they don't even know what I'm doing tomorrow you know you had to book these courses like year and a half ago, so I end up having to cancel that.

Speaker 2: 4:07

I think I'm signing up for another one later this year. I should probably figure out when it is. Um, yeah, yeah, but like you know, you have all these, like you know, have like dawson spear, coice, you know whoever knows like train of thought of, like occlusion and treatment plan and things like that. Before I kind of decided which one I wanted to like resonate with, I kind of like did what I could research wise and like I feel like I I identify with the coice the most. Um, so I took his first course and like pretty quickly became obsessed, along with everyone else, and that's why his courses, his courses, are sold out for like yeah, a year and a half in advance now, because it's like he does not say something if he doesn't have a research article to back it up.

Speaker 2: 4:55

And I think there's very, very, very few ce courses that you will go to, where whoever's lecturing does like these people and I'm not bashing them because, like I don't want to read research all day long either but like people, people say things without like the studies to back it up, like he truly like in like your manual you get. It's like he says something and it's like, okay, these are my sources and they're recent too. It's not like they're from the 1980s, it's like they're all recent articles and it's like holy cow, like this is what? Like the? You know the dentistry that we were taught we're supposed to practice in school, like this guy's actually doing it yeah, that's fantastic, yeah, that's very cool.

Speaker 1: 5:37

well, I mean, I I'm impressed too that you know you've gone so far down the rabbit hole of remote anchorage and you know being able to use hard tissue architecture to make you know full arch work and it's very easy to just kind of, once you get comfortable doing that, I mean you can really just kind of do that and not really be worried about other disciplines, restorative disciplines, soft tissue, which is such a, you know, often looked over aspect of what we do, and it couldn't be more important for the longterm stability of what we do. You know, the side benefit is you get a lot more practice if you don't pay attention to soft tissue stuff.

Speaker 2: 6:11

but it's not exactly productive practice, soft tissue is not done enough, like I can't trust enough to people like how important it is so.

Speaker 1: 6:21

So obviously that's a, that's a big, big note. So where would you suggest people go first for good soft tissue applications specific to implants for large?

Speaker 2: 6:31

um, you know, I think, like dimitri perio amigos, like I think that they do an amazing job nowadays, I they might have a live patient one now. But you know, I did it on a. Um, I did take a course down in Tijuana, uh, which is a hilarious course, cause it was like a. It was like an education center where they were they would also teach implants, and we were, we were, I was doing tissue grafting around a three-year-old implant that had still not been restored at its. You know what we call the Mexican crown, which is just the healing abutment on it. Why are we?

Speaker 2: 7:07

whatever you know, but, uh, you know, I don't. I don't know of any live patient tissue grafting courses. I know there is one in uh, in Brazil and Sao Paulo that uh, I've heard really good things about. Um, you know, there probably is some something in Tijuana, you know. However, it's like, you know, when people hit me up and it's like, hey, like what should I learn to do what you're doing, or to do full arch, and it's like, man, like first, learn dentures, learn how to flap, learn how to take out teeth, um, you know, learn immediate implants. You know, learn tissue grafting, cause it all, it all comes together.

Speaker 2: 7:48

And you know, like, when I, when I mentor people and new people, it's like okay, let's, let's look at what's going to take you the longest, right, like for your case, cause like there's too many people out there spending like eight hours on a double arch, like I hear it from the, the CRNAs I work with, and it's like they're like, dude, you have no idea, like what we did yesterday, and it's like this was an eight hour case and I'm like what the hell took so long.

Speaker 2: 8:13

And it's like, make the flap, you know, taking the teeth out, suturing, those three things are going to take just the majority of the time. I mean, it's all the fundamentals, it's like, but people really want to like skip over the fundamentals and just go straight to four. It's because it's like the sexy thing to do when, like, realistically, a single, a single posterior implant is going to make you more money in your practice than full arches like. Especially if you, especially if you're not efficient at your full arch and I don't care what you charge, you're gonna lose money on that case I mean, yeah, it's gratifying the anesthesia bill for eight hours exactly.

Speaker 2: 8:51

Oh my god I mean. But it's like people, that's what really like kind of frustrates me. A lot of us, like you know, new people coming out of dental school like wanting to like I mean, some of them want to go straight to zygote. It's like, dude, you have to learn the fundamentals, like you're, because you placing the implants for, like I would say, like 80, 90 of the full arch cases that I do or anyone does like, to me the implant placement's the easiest part.

Speaker 2: 9:15

Yeah, right, it's like, yeah, go learn how to take out teeth, go learn how to flap like quickly, efficiently, like without tearing flaps, because the better your flap, the better they're going to heal, the less post-op issues you're going to have, patients going to be in less pain. Um, you know so and that kind of goes back to my residency of of them forcing us, like you take out a tooth, like cool, you can do it flapless, but no, we're going to make a flap because you're gonna graft it, you know, you're gonna put a membrane in, and so I wish, I wish there were more courses on fundamentals than just people ones like, all right, I want to go learn full art.

Speaker 1: 9:54

So I'm like, oh my gosh yeah, no, I totally appreciate where you're coming from and I think you know, uh, like in the first part of a conversation where we're talking about how you got into remote anchorage and Zygos, there wasn't a whole lot of CE kind of on the front end it was, but it was really like you had done so much work to be an efficient surgeon, to know how to do flaps, to understand the fundamentals through your GPR, that you went to one course for Zygos and you were able to do that eight months later because you had those fundamental skills down so well, because you had those fundamental skills down so well. And you know, for me, that's really where my evolution, um, as a surgeon was is when I learned that I needed to focus a lot less on drilling implants and focus a lot more on just creating the stage. And in my mind I was always like, okay, I want to take this case where it's at and I just want to get it to the point where I'm looking at the arch and it looks like a model, like it. Just it's clean, um, the alveolus nice and flat and it's round. Anybody can do surgery on a model, literally anybody, if you see the anatomy, if you see where you need to go.

Speaker 1: 10:51

There's there's absolutely no skill involved. I can say that myself, cause I have very little skill. But if you just know how to get to that point and establish the case, then everything else is easy. And that comes down to being able to lay that flap very quickly and efficiently and not create a massive bloody mess, uh, being able to take teeth out very easily. So you're not terribly fatigued and you know seeing stars by the time you get to the point of actually placing implants Right. So if you can just set that stage efficiently, the whole thing is just so much easier. But it is the most overlooked part of it and everyone just kind of wants to get to that end. Result that really sexy post-op CT with, you know, implants at crazy angles in in in remote bone.

Speaker 1: 11:28

And uh, and I and I think that that really speaks, like your story speaks to that now, now that you've taken tons of courses, you know great you, you've done that but you're able to utilize those and retain them so much better because you have all those fundamental skills that you established early on in your career, like right out the bat, and it wasn't all about oh, I'm going to do full arch.

Speaker 1: 11:46

I didn't, you didn't have that in your mind in school. Even for the immediate period outside of school, you didn't know you want to do that. You thought you were going to be, you know, apa or whoever I don't know Exactly yeah.

Speaker 1: 11:55

Yeah, but you had all those skills you know already kind of laid down. So, yeah, no, I mean I think that's a, that's a huge takeaway. And you know I get people reaching out to me all the time too about you know where do I start, and you know it's it's the fundamentals all the time, and I know a lot of people roll their eyes at that, but it couldn't be more true, and most of the people that come on the show and we ask them what do they need to do?

Speaker 2: 12:19

Like that's got to flap, you've got to take out teeth, you've got to right, you've got to make a good enough flap to where you can really smooth the bone and, like you know, do your alveoplasty and you have to suture Right and and it's, and it's so low risk because that's all going to heal, like worst case scenario. You got to go back in and like alveoplasty a little bit more but you don't have the implant aspect of it and people can try to sue you because your denture doesn't fit well, but like it's gonna go nowhere. But like as soon as you place implants, like you've just opened up like pandora's box of yeah, of risk and it's like dude go do like go to a hundred dentures.

Speaker 2: 12:58

You could arguably like I think like this whole like full arts thing is like becoming like it's like it's cool to do, but like realistically, like everything else, like might be a little more profitable for your office, um, but it is harder too, like I would rather do force and I would rather do like a implant like snap denture, like that's hard every day, oh, yeah, it's so hard, that's so hard implants got to be parallel, like yeah um, you know, like bones got to be like extra smooth patient management, like like go back to the fun models.

Speaker 2: 13:33

If you can do that efficiently and well, like the full arch stuff is going to become so easy yeah, yeah, no, I couldn't agree more.

Speaker 1: 13:43

Um and and two I wanted to ask you. So you were doing, um, you know a fair amount of just going to other offices and doing fuller over there, doing you know, travel, dentistry, essentially Right, yeah. So I'm curious about what the dynamics of that looked like, like you would just kind of walk in, do the surgery, walk out to where you responsible restorative aspect of it. What were kind of like the highs and lows of that experience and how did it contribute to?

Speaker 2: 14:04

yeah, so I still do a lot. Um, I'm learning a lot now where it's like I'm a lot more picky of where I go. Um, so a lot of the offices where I was traveling to it was either like they were kind of doing full arch but nothing well, or it was like they were doing none and I was having to teach them the whole kind of restorative process of it. Um, yeah, and a lot of the places like didn't have the right thing. So I was, you know, for the longest time I was traveling with a trio, so I was traveling with my I cam, um, traveling with you know, and I still today, like have this little, like kind of toolkit I'd go everywhere with.

Speaker 2: 14:41

It's like, if, like, shit hits the fan, like I at least I have something that I'm comfortable with. It's kind of like my teddy bear of stuff. Where it's like I know that, like I, it's like it could be little things. Where it's like it's like a strip, screw, removal thing or it's like, yeah, sure, you know, like an extra, you know a couple extra, like implant drivers, because like cool, you can drill holes all you want, but if you don't have anything to place the implant in with, like you know, like it's just like things that I've like kind of like over traveling that I that I do, and it's in my backpack, like it doesn't like we're going to vegas, so we can write, like it's not going to leave my backpack because it's always in there.

Speaker 1: 15:18

Yeah, yeah, yeah I had a rosen driver confiscated at the TSA one time.

Speaker 2: 15:24

Really it's under seven inches. They shouldn't have done that man.

Speaker 1: 15:27

Well, I mean I say confiscated. They searched it, they were looking at it. They're like what the hell is this? And I talked to him about it and it was okay, but I had to have a conversation.

Speaker 2: 15:34

I made the mistake once I think I had a whole Zygo kit and I said the word drill bit, because I was like, oh, this is in my mind, I'm like this is gonna be really easy for them to understand like what these are. I was like, oh, they're just drill bits for dental implants and they're like drill bits, like that's against, that's against our rules. And I'm like, okay, whoa, they're not like real drill bits. Come on now. Yeah, yeah, yeah.

Speaker 1: 16:05

But I now, I now know like don't, yeah, they don't, they don't fit in an impact driver, yeah, don't call them drill bits.

Speaker 2: 16:07

They're, yeah, they're burrs yeah, yeah um, but yeah, the traveling gig is uh, it's, it's good, it's stressful. You know, last year I took 141 flights, it's about 150 odd days, and hotels, maybe more. Um, wow, I did. You know, I don't think I did my total calculation of arches last year. Um, I know at the end of last year I'd hit a thousand arches wow, fantastic so, yeah, I think last year.

Speaker 2: 16:39

I don't even know how many I did last year, um, but uh, it's, it's good. But again, the thing that people don't think about how many I did last year but it's good but again the thing that people don't think about is like who's doing your post-op? And there are offices that I've stopped going to because I don't know who's doing my post-op. And again, like it's my patient. I did the surgery, it's my reputation, it's my license. You know, if I don't, if I can't trust who's doing the post-ups, or if post-ups are even being done, that's how big infections happen and that's how people end up in the hospital and that's how people get sued. So I know people want to do the traveling gig. It's good, it's great for offices to keep stuff in-house, but you have to be selfish in the fact that it's like this is your license and you've got to be careful and you've got to know who's doing your post-op and you've got to know who the patient is before you even go into surgery too. I mean the amount of times I showed up and it's like patient. I mean there's.

Speaker 2: 17:40

The most recent case was I was sent to CBCT. I was prepared for it. I showed up, they told me the patient was at nine. Turns out the patient was at eight eight 30. They call me. It's like hey man, where are you? And I was like I'm in my hotel room when are you, when are you?

Speaker 1: 17:57

And they're like oh, the patient's here.

Speaker 2: 17:59

They, they, this was an office, like they brought it. Oh, the anesthesiologist here. I'm like, oh, you guys told me nine, two days ago. I show up patient's already asleep. I walk in the room like, hey guys, what's going on, you know whatever. I look down and there's a denture on the table and I'm like, okay, well, the CBCT. I saw the patient had teeth. Oh my God. So I don't know what this is all about. And it was also weird too because, like the the anesthesiologist was like, yeah, she said something about like a sinus lift. Well, I'm like I don't do sinus lifts on full arch, like maybe one or two a year. I might do that. I mean, this is weird. I'm like, okay, well, so you guys got a cbct for this patient? Um, yeah, the other office does, but they're not open today, so we can't get it. And I'm like, well, we're gonna have to wake her up, guys.

Speaker 2: 18:50

Like, oh my god, wake her up take they take a ct, there is a floating implant in the sinus, one implant that's in just tissue and it's a quad zygote case with like mega thin zygote and this office has no zygote. And that was my. That was my final straw. I was like, no, this is like terrible for me, but like I feel bad for the patient. So I was like, well, we need to remove this implant. So I was like, at minimum, I flapped. I opened up the sinus, got the implant out.

Speaker 1: 19:25

We'll go fishing Sure.

Speaker 2: 19:26

But after that I was like man, like you've really got to know what office you're going to Again, who's doing your post-ops, who's doing your pre-ops, Um, so, so the traveling thing, like I still do it um more selective on where I go. Um, you know, I like this year, I really want to chill a lot more this year, like I was. I feel like I was gone last year more than I was home.

Speaker 1: 19:55

Um, yeah, that doesn't sound very sustainable. No, I was literally spending half of the year in hotels.

Speaker 2: 20:00

Yeah, yeah, I just want to like this winter, I just want to ski. Um, there you go, that's all I want to do right now. Um, yeah, that's awesome. And uh, I, I kind of like I'm seeing a little bit of a shift of like what I want to do in dentistry. Like I do miss like the kind of like the quote-unquote, like multi-specialty cases where we're doing some crowns and some single implants and things like that, like the more complicated stuff. I like, like you know, 80 of full arches is just like you know, whatever, like we'll just toss some implants in. It's a pretty straightforward case. But I, I do miss like kind of those more complex type cases. Um, so I I'm trying to figure out a way to kind of get back into doing those, because I do miss a lot.

Speaker 2: 20:44

Um, I want to get back into some like aesthetic type stuff. Um, so you know, looking at CE, like what's next? I I probably some CE for some aesthetics. I mean, like the only veneers I ever did was in dental school. Um, so it's something I'd like to learn how to do again. Um, you know, I the one thing I will never do is insurance driven single tooth dentistry, and it's not because I don't want to do it. I don't believe in that. I think that, uh, dental insurance is well. First of all, it's not. It's not insurance, right, it's a benefit plan, yes, um. So I I refuse to be dictated what I can and cannot do from dental insurance. Um. So you know, what I want to do eventually is is build something where it's like we just do full mouth dentistry.

Speaker 1: 22:34

Yeah, no, I, I definitely think that's. That's really where a lot of this is going, because, you know, when we get too into the mentality of that, you know, fixes the hammer, we make everything a nail. Um, Not only is that, I mean.

Speaker 1: 22:49

I mean, put it, put aside. This isn't good for patients. That doesn't really make sense. And you know we took an oath type of thing, but it's a. You know, I think it ends up being pretty shallow, you know, when your only way of thinking about dentistry is in terms of eliminating someone's natural dentition and replacing it with something fake that we know is not going to be, it's not going to outlive the patient in most cases. I think that that's not as rewarding and there's definitely a reward that comes from tackling a complex case and being able to solve it.

Speaker 1: 23:19

Solve the problem and give someone a fixed rehabilitation for sure, that's great. But there's a world of that with natural dentition as well. That's still very lucrative. It's still very, um, very engaging. It does a lot for patients. It makes massive differences. And it's not just about, uh, the artificial dentition. It's not just about, um, you know, the implants and all these crazy places. You know, it's about comprehensive dentistry and that's really what makes a big difference for patients. And and you can do it much in the same vein of okay, we're going to, you know, you're going to come in and we're going to do a whole bunch of stuff at one time and we're going to change your life in one day. And you can do that, not just with, you know, fixed full arch. You can do it with a whole lot of stuff that's a lot more conservative. Um, you know that works. There's a lot of virtue in that. I respect it for sure.

Speaker 2: 24:06

So what do you like? You know what goes through your head when you look at a patient that could go either way Right, like cause, like I'm seeing, and I'm sure you're seeing it, I think you know, when I talk to people like we're all seeing this where it's like and this is something again, like I don't think talked enough about it's like you have these patients where it's like, you have these patients where it's like we can restore it, we can remove all your teeth. And it's like where, where do you draw the line? And like which way do you go? Because the patients, the patient is always going to take, you know, most of the time, I think they're going to take like the cheaper, faster option, which is generally going to be the full arch, that's the path of least resistance. But like I mean dude, the amount of people like mean I did a double arch yesterday afternoon on a 31 year old, I mean granted, like that was her only option, like she had two, she had eight, nine were the only crowns. Like everything else was broken off at the root line, like bombed out. And it's like I'm like you know that same day I saw a console yesterday.

Speaker 2: 25:04

This chick was 41 years old. She was missing. She had. She was missing one premolar and the other premolar is broken off at the gum line. No periodontal disease. You know, aesthetics was an issue. Yeah, uh, bite was reasonably reasonable. Um and a few cavities, and she was like I want them all out and I'm like no.

Speaker 1: 25:29

Yeah, totally Right Right.

Speaker 2: 25:30

Yeah, and she can, she can get it done, like she'll find a place, like it'll get done, I know. And so, like I spent all this time, like like I paused my day to like educate these people. But this is what's scary, and it's like I don't know like what your rule of thumb on, like when you decided to pull the trigger on doing full arch on someone, or or or either you know giving them the restorative plan and doing it yourself, referring them to someone that can do it well, or or just saying no, like I'm not treating you.

Speaker 1: 25:57

Yeah, I mean it's. It's not something that's easy to be black and white about it, I think. And um, you know, first I'm always looking at um, age is obviously a huge factor. That's probably the easiest one to be looking at Someone in their 30s. You know, there's nothing you can do. That's going to be permanent. You have to consider that Assessing whether or not the patient fully understands that there is options is important. I've had patients that literally just sit in the chair and I ask them why do they want to do this? Why is this the modality they want to do this, like, why, why is this, um, the modality that I'm going to go with? And they've seen multiple doctors and they're like, well, I just don't want to see the dentist again. And it's like, well, that's not. You know, that's not, that's not even a reality. You know that that's a fantasy, that you've been sold and I'm not. I'm not is not, uh, an exit ramp. You know, it's just a different interstate, you know.

Speaker 2: 26:49

And uh, um, you know, it requires more maintenance. I think everyone.

Speaker 1: 26:55

Yeah, absolutely it does. And it's not uh, it's not as easy really as trying to maintain your teeth because it's not self-preserving right Like our. You know what what God gave us is is is it's a, it's a self regenerative system. We're doing everything we can in science to to recapitulate that and regrow teeth and you know, regrow tissue and you started with that. You know, like everything else is is much shorter.

Speaker 1: 27:16

So you know it's very difficult sometimes when you have those borderline cases and I think there's probably not enough people saying no when, when it's appropriate. But ultimately, you know, it does come down to patient autonomy, but also patient education and if we really feel that we've done our job there and this really is, you know, economically, someone's only option for getting to where they want to go, sure, but they have to understand that there's drawbacks to it. They have to understand this isn't a permanent solution. They have to understand that they might be doing this again and as long as that's there and we're on the same page, I feel more comfortable about it. But I think that there's a lot of gigs out there where, you know, everyone's just trying to make their month and you know if it's in the chair and someone's willing to say yes. That's about their only criteria and that's really myopic and I think it's not without consequences.

Speaker 2: 28:06

They're just not immediate consequences yeah, you know, I'm really hoping that. Uh, you know, with like the new, you know basically, with like the way 3d printing is going, we can basically do full mouth dentistry under sedation, yes, um, and immediately load it with like a 3d printed material. That might last them, you know, hopefully it will last them five years, yeah yeah, and that way we can reduce that cost of of saving teeth down.

Speaker 2: 28:34

You know, when you can print it all, like in the same amount of time, it is going to put us to print an arch. Um, yeah, to me that's like. That's what I'm really excited about in the future is not necessarily just doing full arch, but being able to, like, save teeth in the same amount of time. Uh, and for the same price. It is for us to do full arch.

Speaker 1: 28:54

Yeah, no, I, I totally agree with that and I think that one of the strongest driving factors that leads patients who do have other options towards full arch is fatigue, because they understand what saving teeth means is. They're going to go through a litany of appointments over years of time and it's going to cost a lot of money and there's going to be root canals and crowns and stuff, stuff that breaks before the whole thing is even done. Right like that's. That's their perception of it.

Speaker 2: 29:20

Um, because it's going to take so long. But you know, for me, like, dental insurance dictates a lot of that mentality, because it's like, yeah, I this, I have this conversation with patients. Sorry to interrupt, like, but I have this conversation, conversations like all the time with patients where it's like you know they're like, you know they, they roll their eyes about something right, and I'm like I'm like, okay, you know, like let's, let's discuss dental insurance and let's discuss why dentists have such a bad reputation. Yes, there are, like the dentists out there that are ethically not doing the right thing because they want to make money. That's in any business, any industry worldwide. Like you're going to have those people and it sucks, and I, I hope they don't have dental license, cause, like I think that's terrible.

Speaker 2: 30:05

But what, what, the, the what's happening in dentistry that I see with especially these like insurance driven dental offices, right, is you come in, you've got, I don't know, eight cavities, two crowns, maybe you have SRP too. Well, your dental insurance is not going to cover all that. Your dental insurance is going to cover like a thousand, like a couple fillings and use the patients like, well, my dental insurance is only covering this. So, in my mind, as a patient and I know this because I've spoken to patients about this, spoken to friends about this where they're like oh well, my dental insurance, so it must not be that important, because my insurance doesn't cover this. And I'm like okay, so let's talk this through. So your insurance is only going to cover one crown, right? So you're going to get that one crown and then you're going to wait till next year hits. Well, next year you're going to come in for your cleaning and not only are all the things that were there last year that we found still there, but now they're going to be worse and you've got disease in your mouth still. So there's going to be new things. And now we've got this like endless cycle to where it's like, yeah, and that's where the whole like, you know other than the shitty dentist out there. But that's where the whole, like patients like, oh well, like every time I go to the dentist, they just find something new. And it's like, well, no, these are things that we've known about but you haven't gotten treated because your dental insurance company isn't covering them. But you know, we shouldn't be calling it an insurance company, it's not, it's a benefits plan.

Speaker 2: 31:41

It's like I explained to people. It's like I had. I had this conversation with a friend the other day. It was like okay, hypothetically you get in a car accident, it's your fault, you knock out your front four teeth, you break your leg right. You pay your $500 deductible on your car insurance. You get a new car, you pay your whatever your deductible on your medical insurance and they fix your broken leg. Yeah, you get $1,000 to fix your anterior teeth and and and they might not even, and if you want to do implants, they might not even cover it.

Speaker 2: 32:14

They might just tell you have to get a flipper like I'm, like what, what is?

Speaker 1: 32:18

wrong with this?

Speaker 2: 32:18

yeah, that's not insurance like this is not insurance. Like this is what gives the dentist such a bad reputation. It's like so frustrating to me like I left the idaho dental association and I don't pay my dues for that. I don't pay my dues 88s, because like they're getting in bed with these freaking dental insurance companies. I'm like you guys should be going to war against these people, not taking money from them.

Speaker 1: 32:41

Right be the resistance.

Speaker 2: 32:42

Yeah, sure, it's like man I could talk all day about dental insurance. It's like the worst thing in the world, but the one. Dental insurance is good for people that have a healthy mouth, that have no issues, right? Yeah, you get your cleanings paid for, you get your x-rays paid for, but that's all it's good for. Yeah.

Speaker 1: 33:02

If you got one or two problems a year, great. But you know, if got one or two problems a year, great. But you know if you're in a in a rehab situation it's just not going to, not going to go. And then that's why, you know, full arch becomes uh. Or you know, fixed full arch with the dentilation becomes the off-ramp because the thing there's too many problems that insurance is not going to catch up for well and they wait.

Speaker 2: 33:20

These patients wait too long and then, yeah, the full arch is their only option. And the other thing I explained to them is, like your dental insurance company wants us to extract your tooth because it's cheaper than a crown, it's cheaper than a root canal, it's cheaper than a filling, and guess what?

Speaker 1: 33:38

It can't be retreated, yeah guess what?

Speaker 2: 33:39

They never have to pay on that tooth again.

Speaker 1: 33:42

Yeah, they've eliminated their liability.

Speaker 2: 33:47

Let's talk about it it.

Speaker 1: 33:47

This is a huge problem yeah, absolutely, and, like a lot of these fixed cases, patients ask me if they can utilize their insurance. If they've got a lot of teeth, you'll get your insurance. Maximum insurance companies love when they pull teeth and you'll get that, but they're not going to cover anything else and that's pretty much what that has amounted to, like everything you've been paying for. That's what it amounts to is they're going to help you get rid of your teeth.

Speaker 1: 34:13

That's not a healthcare incentive, you know. But you know again, we could wax philosophically about insurance for quite some time, but you know, the overarching theme here is a very important point that you made that digital workflows, comprehensive dentistry, being able to do more at one time and provide solutions for patients is a huge boon and it's not relegated just to implant dentistry. Like, you can absolutely do that with a natural dentition and I think that's that's our third wave. Like, that's where things are going to be going, because we are able to do much more comprehensive things in a cheaper way. Um, because of the, the advent of, you know, digital and 3d printing, and how quickly these materials are advancing. It's absolutely unbelievable.

Speaker 1: 34:56

I mean, when we graduated, the things that we're doing now did not exist. When we graduated and like the materials that are out there, they, it wasn't even a thing. Um, so what we're going to be able to do in the next five years or so, um, you know, with the natural dentition, with crowns, with veneers, you know you name it. Um, it's going to be incredible and I think you're you're laying a really good foundation for yourself. Um, in, in going to, you know, some of these occlusion courses with you know Kois and you know Dawson, you know you name it. Uh, to understand those things, because those are going to become a whole lot more important when it comes to working with the existing competition. So that's fantastic yeah, for sure.

Speaker 2: 35:31

So yeah, as far as like what ce I'm taking next, it's I think that's the type of ce like, um, what's that like? Was it the brum strut and brum like? I think, yeah, I think I'm gonna go try to take that course, like you should. Great things. And yeah, yeah, I took it.

Speaker 1: 35:46

I took it my D2 year actually, really, yeah, I went and I shadowed their office and I took their course and I understood probably 30% of it, you know.

Speaker 2: 35:56

Yeah, I've heard great things and it's like, yeah, it's good, they're good guys. That's the type of you know, I don't know. I feel like it's like the ethically. Like ethically, it's the right thing for me to do and that's going to give me more joy than just ripping teeth out all day long their bonding and what they do.

Speaker 1: 36:15

I mean, I've seen them do a full arch case, Like I've seen how they prep and impress and everything, and you know they've got the in-house lab and they make the indirect temps and stuff and it's a really beautiful thing and it was so.

Speaker 1: 36:39

It was funny because, you know, going through Augusta, like we received such a traditional education but it was very occlusion focused and it was very analog, of course. And but it was very occlusion focused and it was very analog, of course, and it was stone models and stuff. And here I was in this like super, super well-renowned cosmetic practice, seeing those same things that we were doing in school, because they, they stick with those tried and true things and they're doing amazing dentistry with it, really helping people out and solving problems that so many people just you know, they just they jumped to that off ramp. They just take the teeth out and throw in some screws and call it a day and, uh, there's no art in that really, yeah for sure, yeah, yeah, so, um, well, yeah, so let's talk about uh, so you're, you're, we kind of know where you're headed, uh, in terms of CE and treatment philosophies and different things that you want to kind of open yourself up to.

Speaker 1: 37:26

What does it look for? What does that look like for you professionally? Are you still going to be doing the travel stuff? Are you looking to kind of settle on some roots? What's, what's your idea there?

Speaker 2: 37:33

Um, you know I, it's hard to give up the travel stuff. Um, yeah, you know, I'm, uh, I'm licensed in five States now. I'm licensed in California, utah, idaho, oregon and Washington. Um, uh, and so I I'm working with a few different people, um, you know, looking at taking over some offices things like that to you know, that are full arch or that are trying to do full arch. Um, so, yeah, I mean there's I've got more things going on than I know what to do with right now.

Speaker 2: 38:06

Um and uh, it's, it's good. Um, I work with a really good team that helps me on a lot of that stuff. Um, yeah, so I mean I'm excited but, like I said, like this year is for me as more of a year to kind of like try to relax a little bit and cool and just kind of, you know, reassess everything and uh, you know like try to be home. Um, so, yeah, and, and you know, not take really surgery, ce take, yeah, take something different, learn something new.

Speaker 1: 38:42

That's awesome.

Speaker 2: 38:43

Yeah, yeah.

Speaker 1: 38:43

I mean there, I think there definitely is like diminishing returns in terms of the, uh, the surgical courses out there. It's so important to take different courses, learn different approaches and things, but, um, you know, there's definitely something to be said for going back to the basics, the fundamentals that you've been talking about, and there's so much more to learn, um, in that world. Um, so, yeah, I definitely uh encourage people to take a similar route go back to the basics and then, you know, get more complex from there. Um, so, yeah, that's awesome, that's awesome. So, uh, one question that uh, we always want to ask, and and you know, I know that we've already covered a number of, uh, controversial topics that may ruffle some feathers but, um, what's your most controversial opinion in full arch dentistry?

Speaker 2: 39:34

Man, that's a good question. I don't even know, um, um, I don't know if I have much of like a controversial opinion. Um, like, I see the sides to everything, so much you know. Like, like, I think that what we just spoke about, where it's like I think there's too many people taking teeth, that they don't be taken out, like that's. I mean, that's one thing I can preach about a lot, and it's like my rule of thumb where I tell patients where it's like, if my treatment is not going to last you more than five years, then we should look at a different treatment because, like, if what I'm doing to you granted, if the patient takes care of it, what I'm doing for you is not going to last you five years, then we should look at something different.

Speaker 2: 40:07

Yeah, fair and know, some, like some of these massive full arch groups have these crazy consent forms for patients that don't need all their teeth taken out and patients are cause you can't. And I, I know, I know of a dentist that has been sued for doing full arch and someone that didn't need it and going to lose that case. I mean, consent forms are a speed bump. Man, lawyers don't care about consent forms. Um, you know I do, you know some controversial like. I do think this whole like race to the bottom thing is just going to eat, it's just going to screw everyone in the long run. Um, you know, and that's kind of one of the things where it's like, uh, you know, in the last three, four months, where I've kind of like taken a step back and it's like okay, like you know, what else can I do? Because, man, when you're charging such low fees for full arts like it's just you got to keep your doors open, like you've got to pay staff like you know, being a business like, I think one of like the most rewarding things about being a business owner is is having employees like being able to help other people provide for themselves and their family is is, I think, is a privilege.

Speaker 2: 41:18

Um, and I think people take that for granted, that you know, employees are employees. They deserve a fair wage. They, you know, like, dude, being a dental assistant's hard, I wouldn't, I couldn't do it. It's a. It's a brutal job like and. And you know, like, dude, being a dental assistant's hard like I wouldn't, I couldn't do it. It's a. It's a brutal job like and and you know, I don't think that they're appreciated enough.

Speaker 2: 41:36

So like, yeah, the office has to make money, like I have to make money, but my staff have to make money and to me that's really important, um, yeah, so like that's the other reason I kind of like am looking at other things and potentially, like you know, I will never give up full arch, but like opening my my, my toolbox to other things to do more profitable things in the office so that, like I can have more employees, I can pay my employees better, like I mean, like I would love to be the you know, I would love to be the dentist. You know, I would love to be the dentist that pays their employees more than anyone else. You know, like, like that to me is like super rewarding, um, and so, you know, find the best people when you pay them. So awesome.

Speaker 1: 42:24

Yeah, no, that's solid. And um, you know there's there's just a lot to be said for for becoming that dentist, and you know that takes some really good systems and some really sound philosophies and some long-term thinking as well. Um, and I think you you've definitely laid a framework to to build that kind of uh, work environment around you and, and you know, have some people that are going to stick with you for a long time. Um, so that's awesome and uh, and yeah, drew, so I really appreciate you coming on and talking about your journey. So far. It's not been a very long journey, neither is mine, but you have done some really incredible things, I would argue. You've done more than most due with your entire career and I'm so excited to see what you end up doing with it. I think you're leading the way for us DCG alumni, yeah, so I really appreciate that.

Speaker 2: 43:07

It's funny, I had a DCG alumni to sit me up the other day.

Speaker 1: 43:11

Oh yeah.

Speaker 2: 43:12

Yeah, I don't know who it was, but yeah, man, I love it. Man, I think the future of dentistry is bright. I do too, so it's exciting, awesome.

Speaker 1: 43:23

Well, again, man, thank you so much. You brought a whole lot of wisdom onto the pod today, and we even got out of the world of implants and I got a little bit cynical about it, which is fantastic, because I think we're due for that, so I really appreciate it. Thank you so much for coming on. Of course, you'd be welcome back anytime and, you know, if anybody's interested in learning more about Drew and everything he's doing, what's your Instagram handle?

Speaker 2: 43:52

It's the underscore drew underscore phillips. Okay, yeah, man, hit me up like ask me questions, recommend ce courses for me because uh, I'm I'm still addicted to ce and, with you know, people have got good courses to go to like I'd love to to go, and you know, the other great thing about ce is where you meet people. Man, yeah, like, that to me is like, honestly, the best part is like the connections you make with people and uh, it's, that's sometimes more fun than just like I mean, dude, I went to aid and I went to like two lectures, oh yeah, yeah yeah I mean, there's there's usually some nuggets of information, for sure.

Speaker 1: 44:24

but, um, you know, we're we're both going to orca here this weekend and, um, I couldn't be more excited. I mean, the lineup is incredible, one of the best speaking lineups I've ever seen. As far as you know, full arch is concerned, they've done an amazing job organizing that. But you know, I just can't wait to see who's going to be there and who's going to be a cocktail hour. So it's going to be really fun. Yeah, man Cool. All right, man. Well, I'll see you in a couple of days. Thank you so much. I appreciate it. See ya.