The Fixed Podcast

Engineering Excellence in Dentistry: Dr. Sven Bone on Innovation and Mastery: Part 1

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Dr. Sven Bone brings his extraordinary blend of physics, mathematics, and prosthodontics expertise to The Fixed Podcast in an episode that challenges conventional thinking about dental prosthetic design. With his perfectly fitting last name, Dr. Bone's journey from studying complex mathematical modeling in Montana to revolutionizing implant dentistry showcases how interdisciplinary knowledge can transform clinical practice.

At the heart of our conversation is Dr. Bone's innovative approach to prosthetic failure prevention through his company, Smart Mouth Technologies. Their groundbreaking "Will It Break" application employs finite element analysis - a computational method that maps stress distributions in prosthetic designs before they're manufactured. This advancement promises to move dentistry away from subjective rules of thumb toward quantifiable, evidence-based design parameters that can dramatically reduce prosthetic complications.

We explore the critical relationship between clinical excellence and laboratory precision, with Dr. Bone emphasizing how his experience running Bone Dental Lab has deepened his understanding of the entire prosthetic creation process. From standardizing record-taking protocols to ensuring manufacturing quality control, mastering both sides of the restoration equation leads to superior patient outcomes.

Perhaps most compelling is our discussion about patient-specific factors in prosthetic success. Dr. Bone illustrates how two patients with identical prosthetic designs might have dramatically different outcomes based on their unique bite forces, chewing patterns, and parafunctional habits. This highlights the urgent need for more sophisticated diagnostic tools and personalized design approaches in modern implant dentistry.

Ready to bring engineering rigor to your implant practice? This episode offers invaluable insights for clinicians seeking to minimize complications and maximize long-term prosthetic success. Subscribe to The Fix Podcast for more conversations at the cutting edge of implant dentistry.

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. All right, and welcome back to the Fix Podcast. Just to update you guys, I guess it was maybe the weekend before last, the weekend before that everything blurs together, but I attended the first annual ORCA symposium in Las Vegas, which had a really, really impressive lineup of speakers, and one of them is here with us today, dr Sven Bone. He got up on stage and you know there were so many different lecturers there that came from a variety of backgrounds and spoke to so many different things, and it was really an incredible conference. I really enjoyed it.

Dr. Tyler Tolbert:

But Dr Bone got up there First of all coolest name in dentistry, I'm just going to go ahead and put that out there and he got into some really, really interesting concepts. We're going to get into them today. You know including, I mean, dr Bone is bringing a whole lot of experience from a background in physics that we'll talk about. He has his own lab, he's a prosthodontist, he also does surgery, he does full arch, all these wonderful things that we talk about and I got to talking with him after the symposium about some of the things we spoke about and we got into some really cool topics that I just thought would be amazing for the show, and he's been gracious enough to come on. So, Dr Sven, thank you so much for coming on.

Dr. Sven Bone:

Of course. Yeah, it's a pleasure to be here, and I do have one correction I actually don't do surgeries anymore.

Dr. Tyler Tolbert:

Oh, okay. Well, yeah, you've done them. Yeah, you're aware of the concepts.

Dr. Sven Bone:

Yeah, you know my, my implant experiences is I've, I've placed, um, I, probably around a hundred or so, so not not a ton. Oh, okay, and and basically I really dove into the manufacturing, the design, and really kind of stuck with the process, the process side of things.

Dr. Tyler Tolbert:

Got it? Yeah, sure, sure, yeah, well, I mean I think that's all the better and really, when you know we argue that when people go about learning this, learning the process first and then kind of working your way backward is really the appropriate way to do it, because the difference between just being able to say you did this and doing this well really goes down to those types of fundamentals. So I'm really really happy to have you on here and I know you can go deep on that kind of stuff, yeah totally, I think you know, and if we look in the literature you know the number.

Dr. Sven Bone:

if you just look at complications, you're going to see them. They're all kind of a lot of them are orbiting around the process side of things you know on complication rates. So so I think I think a solid foundation in this is is is really critical. Surgery is sexy, right, surgery is, and all the surgeons will admit to that. But the prosth side sometimes that's where things can get really kind of challenging.

Dr. Tyler Tolbert:

Yeah, yeah, and if you're not doing the prosth side correctly, then you'll be doing a whole lot more surgery, but probably not the kind that you want to be doing. Yeah, possibly.

Dr. Sven Bone:

Yeah, yeah.

Dr. Tyler Tolbert:

Absolutely, that's right. So yeah, before we get into brass tacks and everything for those that are unacquainted with you, could you just kind of give us a walkthrough of your whole academic journey to you know what's what's kind of fed into all that? I know we don't have to go too deep, yeah, but but, yeah, let's, let's kind of yeah.

Dr. Sven Bone:

You know, I started out so I left home. I grew up in Western North Carolina as a kid and I left home when I was 18 and I moved out to Montana and so I studied. I knew I wanted to study physics as an undergraduate and so I did. And in that time I you know physics majors have to get minors in mathematics in order to get a degree, and so I was kind of I ended up.

Dr. Sven Bone:

At the time, you know, a big revolution was happening in biology and I became really interested in kind of the biology and and and kind of the biology side. So I took a few biology classes and, um, one of my lab partners was going to be a dentist. And so, uh, you know cause I asked him, I was like, what are you going to do, johnny? He goes, I'm going to be a dentist. And so I'd never thought of that before, never once. And and I started looking into it and then I realized like, wow, dentistry is a beautiful combination of medicine, it's art and engineering really mechanics, yeah and so so I was like, wow, this could be a really good avenue for me.

Dr. Sven Bone:

so so I uh ended up, uh, so I ended up taking more pre-med type classes and decided to go on and finish a degree in mathematics. And so I have two undergraduate degrees, one's in physics, the other one's in mathematics, with more of an applied side. So so basically, it's trying to solve real world, real world problems, like how do we model these sophisticated mechanical problems? And and also I mean just I took a graduate course in in it was it was called like I think it was biologic, biological mathematics and biology, or something like that.

Dr. Sven Bone:

I ended up modeling the calcium fluxes, like the voltages through the heart through the cardiac muscle and also I remember modeling insulin release in the beta cells in the pancreas, so really kind of complex, fun stuff. And so I finished that up and then I applied to dental school and I got accepted to. I think it was there's no dental school in Montana. I got accepted to. I think it was there's no dental school in Montana. So I got accepted to I believe it was Tufts and Boston and UOP and I think Creighton, nice yeah.

Dr. Tyler Tolbert:

So I ended up going to UOP. Okay, very nice, yeah, so I wanted to move to San Francisco and be on the West Coast and you know, I thought it was.

Dr. Sven Bone:

And so I went to move to San Francisco and and and and be on the West coast and and you know I thought it was, and so so I went to dental school and then, when I was in dental school, I you know, western schools are very pro kind of, you know like basically, hey, we're going to teach you everything you need to know. And I, when I was in dental school, I knew that there was more complexity involved with, like full mouth rehabilitations and large like restorative like procedures. So I decided to work for one year after dental school back in Montana, and I encountered some cases that I knew were complex and I didn't feel like I was as prepared as I wanted to be, and so I decided to move on to PROS and I applied to PROS programs and got accepted to Carolina and then Baylor, and so I decided to go to Baylor for my PROS.

Dr. Tyler Tolbert:

Okay, nice, very nice. Um. So yeah, I mean it sounds like you kind of caught that bug uh, sort of on a whim, just like in physics lab and sort of just drawn to the complexity of it. That's fantastic, um, you know, I actually I had a lot of interest in physics while I was in college. I was reading a whole bunch of like Carl Sagan and you know um astronomical stuff and um, I found out pretty quickly you do have to be able to do math to do physics.

Dr. Tyler Tolbert:

And that was that was kind of the problem, that that was what was in my way, um. So, uh, yeah, I was. I stood no chance of being contributory to that field, um, but fortunately I did. I did have a, uh, you know, a mind for biology and things like that and working with my hands and physics kind of had a very roundabout way of sorry. Dentistry had a roundabout way of finding me, but but yeah, that's fantastic. So you went to a prost residency at Baylor and you know you've ended up in Bozeman, so kind of you know what was that journey out of prost residency into dentistry? Did you go directly into private practice or what? What was that like?

Dr. Sven Bone:

residency, uh, into dentistry. Did you go directly into private practice or what? What was that like? Yeah, I worked, um, I, you know, after my process residency, I, I, I just needed a job. So I worked in Dallas for for a couple like two or three years, I think about three years and then, and then, um, and then I was like yep, time to go. So I wanted I knew my compass always pointed back to um, I knew I wanted to go back to Southwest Montana, so it's always felt like home for me and and so so I I just kind of packed up and it was time for me to head on out, and so I came out here and worked, uh, I commuted and worked in uh, a couple of private practices and then, uh, when a space came available, I I started my own practice.

Dr. Tyler Tolbert:

Very good, very good. So you're starting your own practice. It's a prosthodontic practice. I imagine you're doing full mouth rehabs. You're maybe doing some implants. I mean, what was kind of like your, your mix right off the bat, what was really? What got you going?

Dr. Sven Bone:

I mean, at first, I think it's anything you're, you know you. It takes a few years to to really determine what you wanted. Who are you? You know what. What do I want to do, and and, and I think I think focus is is, uh, I think, a key part of evolving as a clinician. I think you find your.

Dr. Sven Bone:

You find what you really are interested in and that's what you're going to end up doing, you know, and so so at first I was did more general dentistry and then now it's. It's pretty much implant based.

Dr. Tyler Tolbert:

Okay, okay. So is there like a network of referring doctors or surgeons that are doing the cases and then they're coming back to you to get restored?

Dr. Sven Bone:

Okay, yeah, it's mostly I do toothborne. You know toothborne rehabs and some, you know it's a. It's a mix, but generally on the full arch side I usually do about two cases to maybe five a month or so, it just depends on the demand. There's not a lot of people in Montana, so it's.

Dr. Tyler Tolbert:

Yeah, sure, I understand. Um so I'm aware, of course, that you have a bone dental lab as well. Um so when did that come about? What was the impetus for starting your own lab?

Dr. Sven Bone:

Um, I started my own lab just because, um, just like anything in life, if you want to truly master something, you really have to do the hard work and dive deep. And so I started. I think I started my lab mainly out of just, you know, in residency we make a lot. I mean, basically we do a lot of lab work is part of the requirement, and so I somewhat missed that. And then also I was really excited about the transformation that the lab industry has gone through, and so I wanted to, I really wanted to dive deep into that, and so I started the bone dental lab, mainly for just my own curiosity, my own desire to control the, I think, really control the the the whole process for my patients, because the, you know, understanding from A to Z is very important to minimize your risks.

Dr. Tyler Tolbert:

Yeah, yeah, no, I totally agree with that.

Dr. Tyler Tolbert:

I think, one of the most transformative times in my own clinical practice.

Dr. Tyler Tolbert:

I do have like an all digital workflow for my full arch now, and so the lab can do a lot of heavy lifting for me, um, but thankfully I there was a time before that for me where, um, I did have an in-house lab and a lab technician that would do all my conversions, and we had a week where I had, um, three double arches and, um, he, um, his father was sick in Israel and he wanted to go back and spend some time with him.

Dr. Tyler Tolbert:

I was like, of course, you know you have to go do that, and so I had to do my own conversions for a week, and that's when I learned you know how good and bad of a surgeon that I was, you know because I figured out what needed to be done in order to simplify that conversion process and by even just like the third conversion that I did that week, I was significantly better and giving my tech a lot better of a time when he came back to do my conversion. So I definitely learned that live, just starting with the end in mind and working your way backward.

Dr. Sven Bone:

You know, I think there's a lot of truth in what you said. Like the best surgeons that I know and work with really understand the prosthetic side and their center synergy back and forth, and and, and. I think that it's inherently a multidisciplinary uh treatment and and and. I think that's what's what's uh. You can't. Everybody has to be on the same page If you want to have the most amount, the greatest amount of success and the minimal amount of risk is that everybody's kind of like mind melded together yeah, you know for sure gotta be reading the same sheet of music.

Dr. Tyler Tolbert:

yeah, um, so with the lab, do you have technicians that are working in there as well?

Dr. Sven Bone:

are they serving like other practices, or is it all just you know the work that you're doing in out of your clinic, or yeah, so we do have, um, we, we do accept like digital, like like clinicians that do have fully digital workflows, we, we will accept cases from them. Um, and then we, locally, you know we'll, we have, uh, in the past we've gone out and done records and do the whole like, basically do the whole thing. Oh cool, yeah, Okay, and so uh. But you know Montana is a big state and so drive in three hours, you know it can be challenging.

Dr. Tyler Tolbert:

No, that's a lot to ask, for sure. Well, fortunately, you know, everything's the speed of the internet now, especially if you're up to date on a fully digital workflow, so that's fantastic. Um, so you know how? Has that kind of experience of building out the lab then kind of taught you more, as you know a prosthodontist like what does that development really look like?

Dr. Sven Bone:

Yeah, it's, it's a it's honestly it's very challenging Like I can't even imagine, yeah, like manufacturing in general, is is a very challenging field and you know my I think that I have a lot of sympathy and respect for for laboratory technicians and and and what they do?

Dr. Tyler Tolbert:

I'm wearing a t-shirt right now.

Dr. Sven Bone:

Yeah, I mean they, they, they really are our partners and and and I think that is I think it's super critical to be you know, to really defend each other and to be and work well together, because that's kind of what really makes the full circle, yeah, you know, so we can have a good outcome.

Dr. Sven Bone:

It's, I think you know, for me, because I do all the CAD designs and stuff for my patients. I tend to get a little lazy with communication with the lab, but I can't under emphasize how critical that is. You know, as far as, like, how your relationships are with your other, with the people you work with, how your relationships are with with your other, with the people you work with. Like, how well do you communicate with them and how clear is your from the clinical perspective? How clearly can you describe what you, what you intend the outcome to be? Because the more information you can communicate with the people that are, you know, fabricating these things, um, the the the better. I think, like I tell my patients, I don't want any surprises and so that's what we write. That's why we kind of go through a lot of that, why I'm very systematic about things yeah, that makes sense.

Dr. Tyler Tolbert:

I think you know, a lot of times there's a bit of a void in knowledge when a dentist is looking for different labs to go to. Let's say you're looking for a digital lab to do your designs and milligrids or conias. You know you'll ask questions about what the lab wants right, like what, what kind of records were they looking for? You know what are the different stages they work with and things like that. But there's a lot of questions I think dentists don't know to ask, right In terms of, like, how they actually make their prosthetics.

Dr. Tyler Tolbert:

Um, you know different, not not even just turnaround times, but just like, what is their quality control? Like, um, you know, how many designers do they have on the team? How experienced are they? What you know, how, how has everything? You know, uh, what are the different departments look like and how has all that flow? And I and I'm curious about you know, with you having such a direct relationship with your lab and them making that final product from start to finish has that kind of taught you some things that dentists might need to be a little bit more discerning about when they're looking at different labs?

Dr. Sven Bone:

Yeah, one is on your end, I think on the clinician's end. We absolutely need to have very consistent and standardized record taking and I think that's been the most powerful thing that has changed just my own pride, like you know.

Dr. Sven Bone:

I came, I kind of like came out of the womb, you know, out of a prost residency right, knowing kind of like, like just having that beaten into my head as far as how you, you know, of a prost residency right knowing kind of like like just having that beaten into my head as far as how you, you know take records and and things and I think that standardization and record record taking is massive, um, yeah, as far as like getting a reducing the entropy or chaos that's in the, in all the the information that that the laboratories receive, and and so I think that, uh, so one is portraits or face scans, um, and then the other one is shades you know, standard shade selection with photos, and then some sort of job relationship record.

Dr. Sven Bone:

You know treatment position, and so, on the clinician side, their responsibility is to determine the treatment position and then also, you know, be able to provide enough data so that the technician can reproduce the patient in their like in front of the screen. And, and that's the goal and that's what I do with all my patients on. So that's helped me on the clinical side and then on the on the laboratory side, on the manufacturing side, they to, um, absolutely understand their materials. Uh, on the cad design part, uh, it's a little chaos out there.

Dr. Sven Bone:

We'll probably get into that yeah, oh yeah, let's do it right and and on the and on the manufacturing, like tool changes, uh things like that. Like all the little details to keep your uh systems uh. Like that, like all the little details to keep your uh systems uh. Like machining, like what kind of validation and verification are you doing for your machining?

Dr. Tyler Tolbert:

Yeah, yeah. So I have two um, you know context, that kind of. They don't educate me about those things, but they make me vaguely aware of them and humble me a little bit. So, uh, my dad uh comes from aerospace engineering, so he had a manufacturing company. He made parts for Boeing Gulfstream and that was like my summer job was working a CNC machine and learning about, you know, quality control and tolerances and you know the human error that can be involved in those manufacturing processes.

Dr. Tyler Tolbert:

And then, on top of that, before I got into dental school, part of the things that I was doing to build out my resume was working at a dental lab. So I worked in the CAD game department for a lab and the number one thing that got drilled into me before I ever learned how to do any type of dentistry was shit in, shit out right, like if the record's bad, their product's going to be bad. And you know, dennis had this idea that somehow, you know, given it's almost like that scene and the really cliche scene in movies where they they zoom into a very, you know, poorly resolved image and then they they resolve it more and somehow it's higher quality after they zoom in, dennis think that labs can do that yeah yeah the, the born, or like the satellite.

Dr. Tyler Tolbert:

Yeah, that's not how data works yeah, yeah, exactly so somehow it's, it's not it longer. Yeah, we're just trying to minimize the loss of accuracy, but somehow we're supposed to create it. But those have really gotten me a better appreciation for what it takes to have high quality records and result in a high quality product. And generally, as hard as a lab's job is, it's a lot easier when that data is accurate and when it's good and it makes the lab, it makes the doctor feel a lot better when things work well. But that's only if they did the records correctly. You can't create accuracy, so but yeah, no, that's, that's really good. So you've got the, obviously your prosthodontic practice, you got the dental lab, and then I also learned a little bit about what you're doing with your smart mouth technologies company.

Dr. Sven Bone:

So can you tell us a little bit about what you're doing with your smart mouth technologies company? So can you tell us a little bit about that? Yeah, so I started a I I I just kind of, I think, just having my background and like a technical background and then also having a clinical background, I think I'm particularly good at kind of teasing out like some fundamental problems, that that where I think we need improvement. And so I started a engineering I guess that would be a tech company really and and I I have about five engineers on staff and we essentially we have a bunch of projects that we're working on, and so the.

Dr. Sven Bone:

I think one of the biggest first projects that we're working on is a web application called Will it Break, and that's a finite element analysis for dental prosthetics, and essentially what it does is it tests designs. So what we want to know, and I think what is really important for designers to know is are their designs set up for failure from the beginning? And so the you you know we have a bunch of rules of thumb, right, you know, cathedrals were built on rules of thumb, but structural engineers don't use rules of thumb anymore to build, you know, uh, skyscrapers and buildings, and you're right, you know that kind of stuff, so we use um. Basically we want. Our goal is to increase the engineering rigor into this space and make it more sophisticated.

Dr. Tyler Tolbert:

Okay, yeah, so can you just fundamentally, can you tell us what finite element analysis is, how it works and exactly what it tells us?

Dr. Sven Bone:

Yeah, so the interpretation. So what finite element analysis is is it's basically a numerical, uh, salute, it's a numerical computational method for solving incredibly complex equations. And and these, when you take a structure or or like, let's say, a full arch, and you, uh, and let's say, a patient bites on it, or let's say they grab some beef jerky and bites down right on that distal cantilever, so what happens is a very complex tensor field is created in that structure, in that full arch, and it what it does is is that that field describes how that force is experienced, I guess, by this, this, uh, by this full, by this prosthesis, and. And so finite element analysis is a numerical method of breaking that, um, breaking that full arch into tiny little chunks. And the reason why that finite element method works is because computers are very, very good at basics, summing up a bunch of little solutions together. And essentially what it does, the output is stress, so it calculates this very complex tensor field that that is created and strain in the in, in the prosthesis, so so so the interpretation of that.

Dr. Sven Bone:

And you can also tack on a failure theory. So so there's theories about a material has, you know, ultimate tensile strength and things like that we can describe those little teeny elements and sum them up and and, and we can apply a failure theory to it and the output is essentially. Here's where. Uh, usually the output is in in a heat map, and the heat if you've ever seen this before, you'll see it in some of the dental literature too. The heat map tells you where the stresses are and then, depending on the material, you can somewhat figure out where it's likely to fail.

Dr. Tyler Tolbert:

Okay, okay, yeah. So something I'm I'm curious about um and I don't mean to break your stride on explaining what, what all this can do Um. So I I saw, you know, in your presentation you had several different um designs. It was actually a really cool. Part of your presentation was just like an A and B of like which one is going to break, and it's just kind of everyone's just being intuitive about it. You're not seeing a heat map or anything and it was very counterintuitive and you kind of talked about the multifactorial processes and stuff like that. But back to my question. So something I'm very curious about and I hear this talked about without a whole lot of really substantial argument. It's just kind of, you know it's hand-waving for the most part.

Dr. Tyler Tolbert:

So, you know, something we've seen in the past several years is the proliferation of direct to multi-unit design, as opposed to using tie bases in these restorations. Through finite element analysis, have you been able to make any conclusions about stress points between those different systems and what's better set up for success long term?

Dr. Sven Bone:

No, I wouldn't say I have definitive evidence on one or the other. I do. I, I can tell you that there is. So, theoretically, when you're designing any kind of complex mechanical system, you want to, you want to simplify as much as you can, and, um, and I think that when you, I, I don't think there's enough evidence to show which one is best. However, there's a phenomenon called tolerance, stacking. So so, when you add a lot of things together and you're trying to to get them all to fit together, you, you compounding inaccuracy, yeah, you compound your error, and so, uh, I think theoretically, uh, direct to MUA is doable. I think there's some, there's some fundamental problems with that as well, um, but I think both are are doable, and I don't believe I can answer that question Okay.

Dr. Tyler Tolbert:

Yeah, yeah, fair enough, fair enough. I appreciate you not having an answer, because most people like to have some time.

Dr. Sven Bone:

No, no, yeah, no, I think I think we should, you know, and that goes on. Yeah, I mean, I think we should have real, actual evidence.

Dr. Tyler Tolbert:

The thing that I've noticed anecdotally is there is some issues with the structural integrity of the. I've heard them referred to as chimneys I don't know if we have a prosodonic term for them yet but the fluted end that actually screws down into the multi-unit if you have a very long flute of this, know, of this thin zirconia material. I have definitely seen that chip. Yeah, oh yeah, that's set up for that yeah for sure.

Dr. Sven Bone:

I mean this goes. This goes down to like who's doing the designing and that that's why wib exists is basically you know that I mean the the who's doing the designing is you're not having a engineer. You know there's not a mechanical engineer designing your designs, it's, it's somebody you know. It's typically you know somebody with like a high school diploma or something like that. It doesn't necessarily mean that they don't know anything about. You know mechanics, but the odds are they don't yeah Right. Mechanics, but the odds are they don't yeah Right. And so I think it's on that side of things, on the design side, there's a lot more emphasis on you know, does it look like teeth? And that's important, but at the same time it's got to work, you know.

Dr. Tyler Tolbert:

Yeah, yeah.

Dr. Sven Bone:

You know it's got to be structurally sound and so I think there's a the, the, the, this pendulum is going to swing. I think, back towards more like we, we, we absolutely know like fractures and prosthetic complications are extremely inefficient part of in our industry, like, like right now, prosthetic complications and stuff are huge efficient inefficiency that needs to be, addressed For sure.

Dr. Tyler Tolbert:

So you know, I'm curious do you think that, um, this is probably a difficult statement to really make, but you know, when it comes down to, you know what is making a prosthesis vulnerable. Is it more so going to be, you know, a design aspect or some some aspect of how that's been configured, or is it going to be more on the fabrication side of things how well lab handles zirconia and centers it, you know so on and so forth.

Dr. Sven Bone:

I think it's a, it's a I hate to say this, but it's a combination, it's got to be. It's multiple, multiple variables, like, come into this equation, and so so I think the I think there's not one silver bullet here to to to go that's going to solve every, all the problems, um, but I think we, we kind of, you know, I, I know that on the design side, um, you know we're, we're very focused on getting a very nice, valid tool for designers to use to help them design better, you know, as far as improving the structural predictability of their, of their um processes, um, and and, and I think, on the lab, on the manufacturing side, um, you know there's, there's other things that need to be done as well. Okay, okay, fair enough?

Dr. Tyler Tolbert:

And and with the, with the uh, will it break application? Um, so I, as far as I remember, when I, when I saw the different heat maps and stuff, it looked like they were mostly being mapped on to monolithic designs. Yeah, um, are you able to do analysis for uh, a system that has a substructure, let's say a titanium?

Dr. Sven Bone:

so yeah, so we're actively working on on on assemblies, essentially and so that would be the term is basically in a complex assembly and then and then analyzing those that that is much more challenging to to code for.

Dr. Tyler Tolbert:

Yeah, I would imagine. Yeah.

Dr. Sven Bone:

And we have to, we have to account for cement and and things like. Right, it's, it's a, it's a, it's a pretty complex problem. I I'm kind of um, I'm really curious about what we're going to find, like I'm yeah, no, I mean I'm really interested in, yeah, and how you know and and and what, what we're gonna see from the design side, and we're're also, you know, we're also embarking on mechanical testing as well, for about you know, you know validation.

Dr. Tyler Tolbert:

Yeah, I think. I think that's great because there's there's just so many different design and fabrication. You know options out there and we all kind of have these vague ideas of what can work in different situations and what you should do, but it's, it's very difficult for us to really quantify those things. Yeah, yeah, you should do, but it's, it's very difficult for us to really quantify those things.

Dr. Sven Bone:

Yeah, yeah, and go ahead, please. Well, that's the goal is to get away from from opinions and, you know, get away from from opinions and have really, you know, quantifiable objective data that we can, can get. That's the, that's the, the future, that's what's going to happen, and, and you know, and, and and so I think we're going to see less polarization, um, as as we get more data, um and so. So we're kind of in the, you know, we're in more of a speculation kind of landscape right now because we just don't have the tools, we don't, you know, and and I, I think, I think that's the key the goal is to is to get as far away from that as we can.

Dr. Tyler Tolbert:

You know, to move things forward, we need, we need the right to the right tools and we need good data ask me you know what's going to be, you know the best restorative material for you know any given case, you know the safest thing to say is, oh, it's multifactorial, right. But you know, really, the answer that people will have is entirely dependent on who they've been talking to. You know their own experience and who they've been talking to. But both of those things are inherently biased, right? You know, some people just swear by monolithic zirconia. It's God's gift to earth, it's, it's fantastic. Other people will tell you the modulus of elasticity is way off and you get saucer defects around implants and all these things. Some people will say you have to have a titanium substructure. Other people say, oh well, then the superstructure is going to be thinner and more prone to fracture or something. We're all just kind of, you know, shooting in the dark. So I'm very interested to see what comes up from that.

Dr. Sven Bone:

Yeah, yeah, me too, and this kind of also. I think this also kind of can go into another. I think thing that's going to impact dentistry significantly too is a lot of our studies and our observational studies and our observational studies, and I think that we are. I think we need to move into more patient specific data. I think we need more resolution on that patient that's sitting in the chair before while we're making these decisions about, okay, what, how am I going to design this prosthesis and how and what you know as far as the implant, the surgical plan and things like that.

Dr. Sven Bone:

But I think, like bite force, just one, I mean a little old lady I think I said this in my talk. You know, a big, massive cantilever totally broke any kind of rule of thumb, but that one is going to do fine because it's in a different environment. We're all different and so you know, a middle-aged male that bruxes is going to be entirely different than a little old lady that's, you know, eating mush all day, you know. Yeah, I mean, it's just totally different environment and so we really need to step away from from these. We kind of need to evolve past like get, get through this. You know, period of, and, and, and and throw down our, our rules of thumb, and, and start using more sophisticated tools to make these decisions.

Dr. Tyler Tolbert:

Yeah, I totally agree with that and I think that, you know, rules of thumb can be very useful because they are able to assume all of the all, of the complexity and the different dynamics that go into these systems as equal right across all patients, and that's great. But, you know, still that's not really enough to inform every decision you make for each patient. Something that I really enjoyed from Dr Sonata, who went, and you know, of course, he was talking about his FP1 cases and had some beautiful documentation and everything, but one of the things that really, you know, I left with was he was just talking about the FMA angle and how he assessed his cases and you know I was aware of that, but you know he was like I can look at a patient and I can tell how big of a problem they're really going to be for me from an occlusal standpoint in terms of the bite forces Just off of that.

Dr. Sven Bone:

Yeah, every prosthodontist is just that they have that burned in their brain. That's the one. Yeah, going through a prosthodontist is basically like I mean, you just show up and it just gets hammered into your head eventually, and eventually you learn. But FMA is a, it really is a very, it is a useful, you know, a tool or a diagnostic aid and a treatment planning aid, but again, it is just an aid, right, of course, and I think that we're even going to get better, like you know what I mean, with more data, like as far as, like, hey, bite, force, things like that.

Dr. Tyler Tolbert:

Yeah, yeah, well, I think, yeah, as we get more. You know technology and metroscopy to check out what occlusal forces look like in a given system, right. You know technology and metroscopy to to check out what occlusal forces look like in a given system, right. But with like um, with like the T scan looking at you know where someone is. I mean, uh, even just knowing how they chew is a really important thing, right. If you're, you're might be concerned about some you know structural, uh integrity issue on the left side, but they never even chew over there, right. So, like, just knowing how they function is extremely important. We don't even really measure for that.

Dr. Sven Bone:

No, no, like the envelope of function, like like where, where, where they're actually spending most of their time, and you know, and, and then, and then we, we have you know, and then, and then more resolution on like what's the pair of functional possibilities, and then how much? Load, could that be?

Dr. Tyler Tolbert:

Yeah, yeah, and, and to you know, we know we talk about, um, there's an issue with making a patient fit a prosthesis, right, and we have these rules of thumb about how much space we need for a given material, um, and why do we think that we have to get to, you know, 15 or 18 millimeters of prosthetic space for every single patient? Um, do you really need to do that? Right? And we're not necessarily making an informed decision, we're just going off again that. Do you really need to do that, right? We're not necessarily making an informed decision. We're just going off again that rule of thumb, and that's affecting how the patient is being treated. It's affecting what you're doing as a surgeon, um, so that's that's kind of an uninformed decision, um, so, yeah, I think we we stand to gain, you know, uh, a lot of advancement in terms of you know how we take care of people and what we're able to do.

Dr. Sven Bone:

Yeah, and you know, I think this kind of segues into a concept of every clinician forms, a model in their head. We have a biomechanical bucket, a biomechanical model. We have an aesthetics and phonetics model. We have like a physiology or kind of a pathology model and a medical model about how this patient is going to. You know, what should I do? So we start filling in inputs in all those buckets and we start figuring out okay, given all this input, what should I do? How am I going to treat this patient? And then what's the outcome going to be?

Dr. Sven Bone:

And I think it's really important, I think, to get to mastery, I think it's really critical to make those models one very diverse, like complex. So you have lots of inputs and you're analyzing lots of different data points, and then I think it's also really critical is to harvest as much experience or much knowledge as you can from your experience points. So every case is an opportunity to make, to enhance those internal models, and so I think the clinicians that reach mastery I'm not saying I'm a master by any means, but I think all of us are, or most of us should be, on that path Like how do I get, how do I really get you know good at this and and I think that's the the kind of the pathway because you know experience, you can kind of rinse and repeat, uh, the kind of robotically right.

Dr. Sven Bone:

Uh and and I think your job as a clinician is to is to really um grow in your sophistication as rapidly as you can.

Dr. Tyler Tolbert:

Right, right, no, I totally agree with that. And I think that a lot of times the feedbacks that we're looking at are not always something that really lends to that kind of mastery that you're talking about. Like a lot of dentists, they take all those different models that you just mentioned and they form a certain formula for their practice and they, like you said, rinse and repeat day in, day out. And you know, sometimes as long as the office is doing well, you know you get this idea that, like you're doing something, you're doing something right and you're doing it the best and other people should be doing it that way too. And you know you're not necessarily committing yourself to excellence that way, because you're looking at different surrogate markers that aren't necessarily, you know, tied to. You know what is the end product, what have you provided for the patient, what's really going to be the best long-term?

Dr. Tyler Tolbert:

And you know one thing about full arch is you know we are measuring our success on kind of a monthly basis. Right, it's just, how much did the office do? How many arches did you do Not? You know, did the thing that you did today is? Did you do not? You know did, did the thing that you did today. Is that going to last the patient 25 years? And we have no idea. But maybe if we had some data we could have a better idea.

Dr. Sven Bone:

Yeah, right, yeah, and, and, and. A happy patient isn't necessarily the best metric.

Dr. Tyler Tolbert:

If it's screwed in, they're probably right, and that's that's not enough.

Dr. Sven Bone:

Yeah, you know, I mean you should look at your input, we, you, you should look at your input. What was my outcome and did I? Did I achieve my goals? And and I think I think that's that's like a um I I think that's so important to to get to a place where you, where we all want to be, you know yeah, and it's it's easy to to kind of rinse and repeat. Oh the patient's happy. You know I must do a great job.

Dr. Sven Bone:

But yeah, but no issues, right right but it's when, because when you have a, when you, when you have that like mentality as far as, like I'm really going to, you know, analyze all of my outputs or all my outcomes, then when you get into a tough one, that's when, that's what's going to save you.

Dr. Tyler Tolbert:

Yeah, yeah, right, so that that that makes a lot of sense. Yeah, cause they're not all easy.

Dr. Sven Bone:

They're. It's like if you, if you look at rebuilding a mouth, it's incredibly complex and and we have great technology. You know like photogrammetry has been a game changer. There's no question about that, and a lot of the, you know, interaural scanners have been, you know, very useful and so. But I do think that they are, but inherently it's very complicated and so sometimes we get bit.

Dr. Tyler Tolbert:

Sometimes it doesn't work, so well.