Dr. Tyler Tolbert: 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. So you mentioned a little bit about digital technologies and the improvement that we've had in record-taking. A moment ago we were getting into CAD design a little bit and I did want to ask know the the relative inexperience of a lot of designers that are out there? Um, what are some of the things that you see in terms of how arches are being designed? Um, that is more often going to lead to failure? Maybe it's getting overlooked um by dentists and they're getting designed back. It looks like teeth. It's screwed in, cool. You know what are some of those like little nuances that should be looked out for that? Maybe we're uncovering from some of this finite element analysis. What are some of those things that people are getting wrong? They're causing mechanical stress.

Dr. Sven Bone: 1:28

Yeah, um. One is um, definitely stress concentrations and embrasures. Um, oh, okay, yeah, so, so, um, and the other one is screw channels.

Dr. Sven Bone: 1:42

So so where, where the screw channels are located and then also the overall implant distribution, so where the platforms are and how well. The takeaway here is is definitely you, when you're dealing with a high stress area, you really have two options in CAD software. You can add material to kind of reinforce it, sure, or you can smooth the. The material so embrasures high pinch points, that's stress. That's where all those tensor fields are going to like, that's where all that stress is going to concentrate in those areas, and so crack initiation and propagation will occur at some of these really high pinch points propagation will occur at some of these really high pinch points.

Dr. Tyler Tolbert: 2:49

Okay, so when you mentioned those embrasures, are you specifically talking about the embrasures between teeth or embrasures elsewhere in the design.

Dr. Sven Bone: 2:53

Yeah, so embrasures, occlusal embrasures, lingual embrasures and facial embrasures.

Dr. Tyler Tolbert: 2:58

Okay, okay. So in areas where that's a little bit too sharp, we have a concentration of stresses and that's where a crack and start and then it can propagate throughout the year.

Dr. Sven Bone: 3:06

Dr. Yeah, and it depends on where the prosthesis is loaded, and so it's hard to guess where that's going to be. But generally, like on the, I know, on my designs I typically on the lingual and occlusal embrasures. I tend to smooth those out more and so that's you know, they're less noticeable.

Dr. Sven Bone: 3:32

That's good, okay, yeah, and then on the screw channel side, we're finding that you know, obviously you want to have the smallest access hole as possible. I mean, ideally it'd be magic, right, we just like they just magically stay on. But we need screws, right, like prosthetic screws are quite simple. You know they have one job to do, and I don't know if you heard in the Q&A session, but basically that you know prosthetic screws have one job and that, and it should be explained pretty simply because that's what they do.

Dr. Sven Bone: 4:17

They're meant to torque, they screw down and they fasten the prosthesis to the platform of the multi-unit equipment, and their job is to maintain a certain clamping force for as long as possible. And and the second job that they have is to, uh, essentially not over, especially like a ceramic or a polymer. So so their job is to get as much clamping force as possible, um, within the limits of, of being able to, you know, without popping the, without deforming the screw. So you're, you know you're supposed to clamp it down with as much clamping force as possible and put as least, uh, stress on the material as you can. And okay, and so, and and the goal is to maintain that until the next like, at least until the next uh recall cycle. So I want people to understand that too is that everything fatigues, right, there's movement and micromotion in all of our prostheses, because the human mouth is a fatigue machine, basically.

Dr. Sven Bone: 5:34

Yeah, constantly, it's meant to, yeah, Going back and forth. So these prostheses and screws are cyclic loaded, you know, all the time. So these prostheses and screws are cyclic loaded all the time. And so the goal with a fixed prosthesis is to get it to at least the recall without any complications. And in your recall exam I would recommend that you validate the torque, that it's maintained sufficient torque.

Dr. Tyler Tolbert: 6:11

Okay, and that doesn't necessarily involve replacing the screw.

Dr. Sven Bone: 6:12

You can just do a torque test on the screw. You can. I, I have a, you know I, I think I I have. I go back and forth on this because it it does. It does get a little complicated there as far as how much actual stress is on the screw shaft itself, so you can plastically deform them and then you're, you're, you're done. You know I mean so. So so I, I would probably do a two strikes, two to three strikes rule, like if it's not sufficient torque, you retorque it, um and then, and then, essentially, if you find it loose, you know, if it's kind of not to spec, uh, you might want to, you might want to replace it at that point, or you could do it one more time and then replace it, but I would replace the screws and you're talking about a separate recall appointment.

Dr. Tyler Tolbert: 6:59

So let's say they're coming in on a. Do you recommend six month or yearly basis?

Dr. Sven Bone: 7:02

I see my patients annually. Yeah, we do too. Yeah, I do, I, unless I. I mean there's some that I don't. But right, but the, the, the, the classes, the, the what's the protocol? Yeah, the ones that I'm not really concerned about. As far as you know, six months, then a year, then I can space it out to a year okay, but I do take radiographs annually of course always yeah, um, so yeah.

Dr. Tyler Tolbert: 7:31

In other words, you know you, you see them in the recall, annual recall. Uh, you, can you do the torque test and, let's say it, your torque wrench, or whatever you're using, doesn't break immediately. You feel it tighten a little bit. You should probably notate that you have tightened that screw in particular and so that the next recall appointment, if that happens again, you're like okay, that's two strikes, next time we're going to replace the screw, is that? Do I follow that?

Dr. Sven Bone: 7:52

yeah, okay, okay, yeah, because the the universe wants those screws to unwind like yeah, that's the basic. You know, uh, you know, I think it's the, it's basically the uh, second law of thermodynamics, right, the entropy is, is, in this case it's, it's always going to tend towards more disorder, and so so the screws they, they will never tighten, they're not going to self-tighten, they're always going to loosen there's no megantropic screw out there right now.

Dr. Tyler Tolbert: 8:26

Right, it's not going to happen, and so so you.

Dr. Sven Bone: 8:30

Your assumption is you always have to walk into this, into a recall is that the screws have been under cyclic loading and fatigue and they they are, are prone to that. You should assume that they're loose, okay.

Dr. Tyler Tolbert: 8:46

Very good, and yeah, go ahead.

Dr. Sven Bone: 8:48

Yeah, so, so, so the the key is is is really that and understanding those parameters, like I mean that that evolved to the Badger screw, the screw that we developed as, basically as a side project, and, and I was, like you know, hey, this is, uh, you know, a class one medical device.

Dr. Sven Bone: 9:09

Let's, let's go ahead and and, uh, you know, let's, let's start with the problem first and define our performance requirements, which is, I think, the opposite of what has been done traditionally and in engineering. This is like how you really do it. One is, you define the problem and you establish your performance requirements and then you iterate and design to those requirements. So, so, that's, that was the the prop, that that's the uh design process that we, that we have and that, okay, we take so, so, yeah, we we've kind of we've opened up the, the can of worms that is, prosthetic screws.

Dr. Tyler Tolbert: 9:48

You've, you've done it now. So, um, you know, I was thinking, um, and setting up for this interview, I was kind of thinking about you know, how do dentists generally think about screws? So, you know, every couple months nowadays, a new screw comes out and people are talking about it, right, and so usually the things that people um want to know about it are uh, does the screw come loose? Like what, what screw loosening is coming out, and usually that's one of the first marketable things about it. It's like, oh, this screw is never going to come loose, right?

Dr. Tyler Tolbert: 10:12

Um, people want to know, you're right, people want to know how much angle correction can I do with it? Um, they want to know, uh, you know, if they're getting into, especially if they're doing some FP1 stuff, if they've got some design experience, they're worried about the size of the screw channel, yep, and usually the end all be all is going to be price, right? So, like, is that a pretty decent rundown? Are there things that are being, you know, tragically overlooked? Like, what should people really be thinking about when it comes to?

Dr. Sven Bone: 10:38

screw. Well, I think there's like kind of ease of use and ease of manufacturing features, right, I mean, those are very reasonable. But I think screw performance is basically not even talked about. Like there's no, right, there's no like we know exactly. You know, we have a very, very good idea of what kind of clamping force our screw generates. We also know how much stress it generates and we also have the smallest access or screw channel on the market and those are basic parameters. That, I think, are, you know, as far as performance parameters. Those are very key. Um, the other thing I would say, um about angle correction is ideally, you want to on the surgical side, you really want to focus your, you want to focus your attention on implant timing and, anyway, selection, always, yeah, always, selection, always, yeah, always. Um, if you can avoid um angled screw channels, you should. I mean that, okay, that would be the. The ultimate goal is to uh, is to make things less uh on the manufacturing side. It's so much easier just to to machine a.

Dr. Tyler Tolbert: 12:02

Don't rely on angle correction as your as your fudge factor, and so the main, the main reason for that being that when you have an angle screw channel that creates some manufacturing errors, and workarounds need to happen that can cause some structural integrity or or something else.

Dr. Sven Bone: 12:19

Yeah, I mean generally, you have to remove more material. You have to remove more material. There's no question about that. And and also it's um, it and that is going to uh, increased stress, uh, or potential for crack propagate, uh, initiation and propagation because of stress concentrations. Okay, yeah, and, and so you, so the you know, it's just you put a big hole in it. Basically, yeah, fair enough.

Dr. Sven Bone: 12:50

You know, and so so you do want to minimize that and and sometimes you have to angle correct. I mean, if I do what I do currently is I I'll. If I do have a certain uh abutment that I absolutely need to angle correct, I usually use a tight base. I usually use like an angle corrected tight base. It's much easier to, I can. I'm removing a lot of material and it's not. It's not ideal, but I can machine those quite. You know, we can machine those pretty precisely Okay.

Dr. Tyler Tolbert: 13:23

So like a custom angle, corrected tight base.

Dr. Sven Bone: 13:26

It does kind of add some some. I mean it's not ideal. So so really, what we shoot for is in in the surgery, really, really shoot for that. You know implant timing, emulation selection.

Dr. Tyler Tolbert: 13:39

Yeah, yeah, that's something we stress a lot when we talk about you know surgical nuances and stuff. And it's something I've I've spent more time on over time.

Dr. Sven Bone: 13:46

Yeah, and you know, I, I, I teach with Simon O and Juan Gonzalez and, and you know that that is what I see very consistently from from really good surgeons is they, they just they have it nailed, you know, you know they, they're really, they have it nailed, you know. You know they're really good at getting an understanding how to place multi-unit abutments and, um how to time the implants correctly.

Dr. Tyler Tolbert: 15:14

Yeah, right, right now, the thing that makes me most proud from a surgery, it's not torque values. Uh, it's not my surgery time, it's just access holes, and wasn't you know straight on Like that's. That's pretty much the only thing I want to show in Instagram posts now.

Dr. Sven Bone: 15:28

Yeah, and I go, I go to all my surgeries and basically, uh, it's a team effort. You know I'm out there to make sure that the, that I'm getting what I want. You know what my goals are for the, for the outcome of the surgery.

Dr. Tyler Tolbert: 15:41

Yeah, yeah, and something I wanted to throw your way. I actually saw it today and we'll. I definitely want to come back to screws, because I have more questions for that, but there is a product coming out, and I won't say it by name, but I've kind of thought about this concept before, definitely not far enough to ever make a patent or something like that. But now that this this product's out here, so there's a, there's a continuously variable multi-unit right that kind of has like a ball joint on it and you can sort of unscrew it, pick whatever angle you want it's infinite degrees of freedom and then you can screw it back down. Uh, do you see any issues with that biomechanically? Just just you know off the top of your head, do you? Do you think of thing like that?

Dr. Sven Bone: 16:18

like we definitely need fatigue analysis, like cyclic loading and fatigue testing. On this ability, and then also on the digital side, I think that you certainly could set an angle and if you're doing photogrammetry data, I think that would um, it should work well and hopefully that is quite stable um, and then you should be able to design to that and and yeah, you know it, it, it could work, I, I, but but I think mechanical like it does need validation, it needs right, you have to put it up, that kind of scrutiny, scrutiny for sure, cause if it's not stable, then we're adding a more, uh, mechanical, uh, you know, chaos into the system, so so so I would be, um, I mean, it could work well.

Dr. Sven Bone: 17:18

Yeah, I, I think it just needs to be validated.

Dr. Tyler Tolbert: 17:22

Yeah, it can make our jobs a lot easier if it works right.

Dr. Sven Bone: 17:26

Yeah, I mean it could. It could work well. I think that you could also um get great results with implant timing and MUA. Oh, totally, yeah, no, no question about it.

Dr. Tyler Tolbert: 17:38

Yeah, that's still a fundamental skill, for sure, um, but yeah so, so back to uh, back to prostate screws. So you talked in your um, your presentation, a lot about you know, screw performance and how that's quantified and the different things that you actually measure, and I actually thought it was really interesting. So you've mentioned clamping force a few times. Yeah, um, can you kind of speak to what that really is, how you measure it, how, let's say, your screw stacks up against other screws? You know what's like. I guess I should ask too, like, what is one of the most important things that we should be looking at when analyzing screws? Like, what's the data that matters a lot.

Dr. Sven Bone: 18:08

Yeah, I, I'm. So. One is we need, depending on the like, how much load or force that the patient is applying. We need to make sure that we're our our the preload or or clamping force, okay, so that's the same thing. That that's applied is sufficient to maintain stability of the bolted joint. Soing force is a pretty big, important number to know.

Dr. Tyler Tolbert: 18:41

Okay.

Dr. Sven Bone: 18:45

And then on the other parameter, especially on provisionals that are usually like some sort of polymer, right, this 3D printed or milled PMMA, we also want to look at how much stress that's applying on the material and so these polymers can deform, right, they can actually yield, and so we want to try to minimize the stress on those polymers and also ceramics too. I mean, zirconia is a very, very tough material. It's a very strong material and so you might get away with more on zirconia than you would provisionals, but in general, that's what you're looking for, that's the kind of that's what you're looking for. Okay, the other parameters could be access hole. Like you know, for certain, like FP1s, access hole is going to be more important than like a giant. You know huge. You know Zygo case with you know it's got massive amounts of material, yeah, yeah. So but for our, you know, know, as we kind of get into that, like fp, like small profile prosthesis, you know um, kind of like small fp3s, uh to fp1 type of treatments or fp2, which in reality most of them are um, then then you know, I think access hole probably would also be a parameter to look at Um.

Dr. Sven Bone: 20:26

And and then an angle. I think an angle correction solution is it would also be a good feature to have too. I think it's not your like. I said it's, it's, it's, it's a. To call it a feature is it's? It's not an anti feature, but it's kinda it's not, it's not ideal, it's, it's kind of a bailout feature.

Dr. Tyler Tolbert: 20:50

I see, okay, yeah, yeah, that makes sense.

Dr. Sven Bone: 20:52

So so the badge, the badger screw, is not angle corrected because we wanted to first start with that, and we do have a honey badger that's coming out.

Dr. Tyler Tolbert: 21:03

That just doesn't give a shit.

Dr. Sven Bone: 21:10

So that one is in development now and so we'll be launching that one, you know, fairly soon too. But that that's a that's a unique, it is a unique challenge to to kind of you know. But but I think we have, we'll have a really good solution.

Dr. Tyler Tolbert: 21:31

So what are some of the? So, if we just talk about the, the Badger screw for now, what are some of the design nuances that have really optimized its clamping force and the screw channel access?

Dr. Sven Bone: 21:43

Yeah, so it has basically a concave profile and through a bunch of iterations we ended up with that profile through just basically computer aided engineering. So so, through this process of knowing what kind of design parameters we wanted to to our performance goals we wanted to achieve, that's the. That was the kind of the fruits of that. So, instead of like hey, I've got a great idea for a screw, this is what it kind of looks like and stuff. We, we didn't do that. We, we started with with like, hey, I've got a great idea for a screw, this is what it kind of looks like and stuff. We, we didn't do that. We, we started with with like okay, here's the problem. What is the? What is a? There's a big difference in this, in that, in that approach, and and so so that's.

Dr. Sven Bone: 22:28

I think that's what makes you know great, you know clever engineers, so powerful and and and you know and and and so. So that's, we have a concave profile and it is centering by nature, which is actually a good thing. Um, because what I do is um, usually I always have at least three centering screws in my um, uh, in my uh designs. So I'll usually place an anterior screw first. I used to, you know, when I was doing these, like early on, I would like put screws in and try to retain them and then shove it up in there and then start screwing it down.

Dr. Sven Bone: 23:09

I do not do that and I wouldn't recommend that. So what I do is I put a centering screw in first uh, usually in the anterior and then I evaluate. Um, I look for how much displacement we're off, like in a zirconia prosthesis. So I look for. You want to see a bullseye right into the, to the threads of the mua, so I evaluate that for the, because I'm looking for distortions.

Dr. Tyler Tolbert: 23:37

It's kind of like a. It's like a Sheffield test a little bit it is.

Dr. Sven Bone: 23:41

And yeah, and passivity is very, very challenging to judge clinically. Okay, yeah, yeah absolutely it's, it's very hard.

Dr. Tyler Tolbert: 23:51

So when you use the term centering, are you referring to the, the centering of, like, the screw hole itself, onto the multi-unit channel? Yeah, okay.

Dr. Sven Bone: 24:00

Yeah, so the nature of the screw head, as you clamp it down, causes the prosthesis to center on where the threads, on the axis of the multi-unit, or at least on the axis of the threads.

Dr. Sven Bone: 24:17

So it causes it to to center right okay, okay and yeah, and then, uh, if, if that, if, if those look like, if I'm seeing bullseyes, then we go posterior, posterior, with centering screws and then if I have like a tie base or or, or basically a like a flat ended screw that has more play in it, then, uh, then I'll seat those, cause I know that the prosthesis is is uh, it's, it's seated.

Dr. Sven Bone: 24:46

Yeah, it's centered and so I and, and what I do is I don't, I don't tighten them Right, you snug, um, so it's, it's kind of like a five Newton type type of five Newton centimeter type of torque, so and so that the prosthesis is at least centered, and then, and then we start slowly, you know, in a star pattern, start slowly getting to our store, our torques back.

Dr. Tyler Tolbert: 25:10

Okay, yeah, cause I've definitely had situations. I've used a fair number of screws, I guess, where you know I'm usually putting in the anterior first, just because it's generally the easiest. And then you know, sometimes you'll get that snug feeling and then you go trying to screw in something else and like it's just completely off base, like it's just not hitting, or you know, maybe you get a couple more in and one of them just won't go. So you have to loosen up the other guys and you get this one tight and you're just kind of chasing your tail trying to get this whole thing to screw in and you're probably introducing stress into the situation, especially if it's surgical type.

Dr. Sven Bone: 25:42

Yeah, and that's somewhat diagnostic, right. I mean basically hey, there's, you know, I this is not, I'm fudging right. Yeah.

Dr. Tyler Tolbert: 25:50

I'm bending the restoration to screw it in at this point. Yeah, yeah, and, and so it's it's so.

Dr. Sven Bone: 25:55

That's, you know, that's a diagnostic, that that's an indication that, hey, you know, usually, if I do find that, I will often go back to the manufacturing part and and and find root cause, like where's the error here? But but a lot of but, a lot of times I don't I, a lot of times what I'll do is I will tighten it down, you know, and hopefully everything seats, but I know that we're going to have to redo this.

Dr. Tyler Tolbert: 26:28

It's going to be a problem, but there's an art to seating Like.

Dr. Sven Bone: 26:33

There is like a. There's an art to seating you know what you don't want to. There is like a. There's an art to seating you know the you. What you don't want to do is take a flat screw and just screw it down as tight as you can and then start forcing everything else that you have to be systematic, but that's what I found that seems to work well is is I have a centering screw, at least in the anterior and in the posterior, and then I can at least get it lined up.

Dr. Tyler Tolbert: 26:57

Yeah, okay. Yeah, that's, very good Very good and as far as um. So I'm curious about so different screws that will come out. They always have some uh, torque value associated with them. Um, some of them you torque to 10, others 15 others, 20 is a. Is a screw that can tolerate a higher torque value when you screw it in? Is that inherently better? Are you going to have better clamping force from that?

Dr. Sven Bone: 27:18

No, Okay, so it absolutely depends. When you have a torque wrench and you torque to 15 newton centimeters or 20, what does that actually mean?

Dr. Tyler Tolbert: 27:31

Right, Right, I don't know. I don't know what it means.

Dr. Sven Bone: 27:36

So what you have to do is you've got to break it down into the components. So this is kind of classical mechanics type of stuff, newton stuff. So when you want to, you know, when you have a force, or in this case it's a rotational force, the torque, we're going to break it down into the three components. So one is you've got friction associated with the screw head, the bearing surface friction, and then you have preload, that's the actual resistance to stretching right. And then you also have thread friction. You have friction on the threads, and so the way to break this down is that thread friction is about five to ten percent because it's lubricated almost all the time. It's never dry, it's it's, it's lubricated. So so you can account for maybe five to ten percent of friction from that. So we can kind of ignore that.

Dr. Sven Bone: 28:32

So the biggest one is the screw head design, the contact patch, like how, which is the bearing surface, and and then the stretch of the, the preload. The preload is what we want. So so you can uh, so basically that contact patch, the resistance, resistance is going to steal a rob from preload, so it's going to friction, is going to take away from you stretching the screw. If there was no friction, then it all be screw stretch If there's no friction in the system it would be all screw stretch.

Dr. Sven Bone: 29:13

So 15 Newton centimeters for one screw will. For one screw we'll get one, a certain amount of preload, and then for another screw it would be a totally different preload.

Dr. Tyler Tolbert: 29:24

Yeah, so I like I usually think in terms of extremes to simplify a concept. So you know, if I, if I torque this to 20, that might just be telling me that there's a ton of friction, uh, between, like, the screw interface and the material. It doesn't really tell me anything about how that screw has actually been stressed and preloaded.

Dr. Sven Bone: 29:39

Yeah, yeah, got it. Yeah, if you have a high, if you have a screw that has a high amount of friction on it you might. Your clamping force might be too low for to maintain stability.

Dr. Tyler Tolbert: 29:52

Okay, okay, yeah.

Dr. Sven Bone: 29:53

Interesting and and so so that's why you, that's why you really got to know what what that stress is. And uh, you that's why you got it, cause stress is a, is a is amount, is basically a force on that comp and the amount of area that's on that contact patch or the bearing surface. And then, and then that's why you really got to know clamping force, like what it actually brings, and how you can, you can mechanically test that with, like a load cell. So so you basically screw the uh, screw the screw down to spec, and then you see how much force is generated on the uh, on the material. So you, there's, there are ways to validate that.

Dr. Tyler Tolbert: 30:35

Right, right, okay, that makes sense. So really, the, the torque in and of itself, I mean that's, that's a, it's almost like I mean it's rotational, and all we really care about is the, the direct vertical force of the screw onto the material, cause that's what actually keeps it off.

Dr. Sven Bone: 30:48

The rotational force is kind of irrelevant and think of, think of preload or clamping force is like a shock absorber, right, so it is. It's constantly pulling down on this thing.

Dr. Sven Bone: 30:59

So, so that, so that it can handle and resist all these, all these, like you know, you know the chewing and rubbing, you know, whatever the hell they're doing like you know, like basically it's like a shock absorber, and and when that starts to deplete, when they start unwinding, then then you get micro movement of the prosthesis, you get work, hardening or crack initiation in the fruit itself, where, on the platform, all these, like all these little things that occur when, when clamping force is is reduced by half. In fact, if clamping force is reduced by half, in fact, if clamping force is reduced by half, the screw's unwinding.

Dr. Tyler Tolbert: 31:40

Okay, yeah, that makes sense? That makes sense. So is um. Is that to say that the more clamping force, the merrier um? Or is it more so? You know, maybe the um, the degree by which the clamping force is reduced over time. That's more important.

Dr. Sven Bone: 31:58

Yeah, so so, um, that is so. The more of the clamping force, the merrier is, I think. I think theoretically, yes, you want, you want to maximize clamping force and I think that is important, but it's definitely more. At what cost are you getting that for?

Dr. Tyler Tolbert: 32:28

Because we can reduce that bearing surface friction to a very teeny little contact patch, but the consequence of that is super high stress, and so we might so we might be fracturing and yielding, yes, and deforming our material yeah, so there's definitely a balance there, because if I, if I put too much clamping force in a small area because I've tried to reduce that friction, to increase the preload, now I've created a whole another issue of actually like fracturing material causing crack propagation. Okay, this makes sense.

Dr. Sven Bone: 32:58

Yeah.

Dr. Tyler Tolbert: 32:58

Okay, nice.

Dr. Sven Bone: 32:59

Yeah, I hope that. I mean it's. It's not that complicated, it's kind of complicated, but not not too complicated.

Dr. Tyler Tolbert: 33:06

Yeah Right, Right, yeah, I mean it's. It's more complex than you know. I screw it into a high number and that means it's going to stay right, you know, and that's that's. That's kind of how I thought about it for probably most of my career. I think I very recently started thinking more about it. Yeah, yeah, I mean yeah.

Dr. Sven Bone: 33:21

I mean, honestly, our job is clinical. We're not, you know, we don't think about, you know, the the, a lot of the mechanical stuff behind these things. We, you know, and it's, it's that, that's you know, I mean, that's why we have engineers, right. For sure, yeah, absolutely Our airplanes fly, our cars get us from A to B. You know, and and you know, there's a lot of of expertise that goes behind that.

Dr. Tyler Tolbert: 33:49

And those are considerably more complex than our restorations, I would assume so.

Dr. Sven Bone: 33:52

I don't know man Well who am I telling? There are so many unknowns that we have and just in our, it's actually very, very complicated. I would say it's. It's tantalizing for an engineer. It's complicated enough. We're not making engine mount brackets or something like that. Our problems are actually way more complicated than we would realize.

Dr. Tyler Tolbert: 34:27

So I'm curious you talk about a lot of the testing that you guys are doing throughout your various design interfaces. Have you been testing like other screws, other materials and things like that and kind of seeing how competitors stack up like are there? Have there been some surprises and like design nuances that people get excited about? But maybe you know when you actually do the testing.

Dr. Sven Bone: 34:46

Yeah, so mechanical testing is is um's, it's quite expensive to do it and, and maybe that's one reason why we don't have a lot of data in it, but most of ours, most of our testing has been computationally so. So so we, we, we, we definitely know what competitors are, what the performance of the competitors, at least from an analytical point of view, and but. But unfortunately, there's not a lot of studies out there, there's not a lot of like academic research on on this. So so we're, you know, I, I, I don't, we haven't really I, I, I don't, we haven't really um, I mean, I think, I think it would at some. At some point we'll probably do more rigorous, uh, mechanical testing, um, but but I think right now we're just kind of really focused on on our screw and making sure that we have the. We have the best screw on the market as performance wise.

Dr. Tyler Tolbert: 35:50

Great, great. We have the best screw on the market as performance wise, great, great. So, as far as indications for the Badger screw, what is it useful in? I mean I I heard you know FB3 obviously we've been talking about that Is it great for all materials or are there certain limitations of it, or is it a universal thing?

Dr. Sven Bone: 36:06

I think I mean we have not really optimized it. I would say it's say it's for titanium. I don't know, we haven't really it's not the point, for we haven't optimized it specifically for titanium.

Dr. Tyler Tolbert: 36:24

We have really optimized it for polymers and ceramics, like that's really kind of what's our focus on that yeah, yeah, and being that there's like a small screw channel access, I would assume that's great for fp1 and yes, you know different applications as well okay, yeah, fantastic, and that's available now and people can look up the battery screw and give it a shot yeah, so so we should by the mid-march, like early march.

Dr. Sven Bone: 36:49

We're on pre-order status and so okay, so the what we have now is the. The latest updates that we have is that we should be, uh, shipping in, um, uh, I think, mid-march. This is when we're anodized. We're doing a nice anodizing process too, and so they're made. And the other thing that I thought was really important they're made in America.

Dr. Tyler Tolbert: 37:18

There we go, Coming out of Montana. You know it has to be yeah, yeah, man.

Dr. Sven Bone: 37:25

I was like you know we got to do this Like let's make these in America, let's, let's have our. I mean we have awesome, you know, machine like, basically industrial machine shops that that have. You know, we're vetted with great iso standards. You know, as far as, like, all the stuff that we all the boxes that we want to check our tolerances are amazing, um yeah I'm really impressed with the manufacturing.

Dr. Tyler Tolbert: 37:53

Yeah, and you know that's a, that's a whole nother aspect to you know, choosing screws and really even implants as well, is that we don't even really think about is where are these things getting made? How are they getting made? To what standard they're being made? I mean, I've never even really I barely ever hear anybody even speak to that. You know, when they talk about different products and options that are out there. So that's that's good that you've gone through the that type of rigor to figure that out.

Dr. Sven Bone: 38:14

Yeah, yeah, I mean it's, it's, it's very important. I mean the FDA they do have to like if you make an implant or an abutment or something like that, they, there are, you know, iso standards that have to be made in order to get it, uh, you know, cleared. But but yeah, yeah it's, but, but yeah for for our um, for our screw. You know, we, we're super happy.

Dr. Tyler Tolbert: 38:37

That's awesome. That's awesome. Well, I congratulate you on on innovating there and, um, I definitely feel like you were, you know, uh kind of taking taking the industry to task, um to you know practice some uh things that we see in the automotive industry and aerospace and hold ourselves to a higher standard and kind of catch up with the times and other industries, because it's long overdue. I mean, full arch is becoming so incredibly ubiquitous and you know everybody and their cousins trying to do it and if we're not holding ourselves to that high of a standard, we're going to see a lot of problems coming down the line.

Dr. Sven Bone: 39:05

So yeah, I mean these, these, I mean these go in patients' mouths. You know these are people. Yeah, we really. Yeah, I mean, I think, I think that, um, I think the industry in general like that, like like it's going to get way more sophisticated, like it should, and I think it will. You know, yeah, so and and and it's going to be for the benefit of the patients, it's going to be the benefit of the clinicians and on the laboratory side too, I mean everybody. You know, with more sophisticated tools and advancements, you know we can definitely make this. You know, very costly and risky surgery and risky treatment. I think we can make it better and we should. We should be the gold standard as far as in medicine. Hey guys, our stuff lasts like 20 years.

Dr. Tyler Tolbert: 40:04

Yeah, that's true.

Dr. Sven Bone: 40:04

So that's our goal, that's our mission Very good, very good. So I, I, that's that's our, that's our goal, that's our mission.

Dr. Tyler Tolbert: 40:10

Very good, very good, yeah. So to to speak to you, know your goals, your missions with smart tech, with your, with your lab, with your office, like what are you know your biggest professional goals and ways that you are looking to impact Full Arch, beyond what you're, what we've already talked about.

Dr. Sven Bone: 40:26

I, you know, I think I love clinical work. I mean, I love being a clinician. I think I always do it and so I think that's never going to go away. But I think I'm most I love working with my team of engineers and I have like three jobs, it feels like, but I'm always working. But I really do love the um, the innovation side of things. So so I, I, um, so I'll probably definitely uh continue with with uh, leading teams of engineers for, for innovation, and that's awesome and I think I, I have that um, I think what's very helpful for them is that I have, I can live in both worlds.

Dr. Sven Bone: 41:12

So so I understand a lot of the technical things that they, that they work with, but I also have that, that clinical insight as well.

Dr. Tyler Tolbert: 41:21

Yeah, yeah, we need people that can be that bridge. For sure, you know, hopefully we'll. We'll be looking at a future in the, in the very near future, where you know we look at all of our restorations and we know where their stress points are. We can, you know, assign that to every patient and know where their stress points are. We can create a model for, um, you know, uh, mitigating disaster long term and make our work last a long time. And you know there's downstream effects of that, where the end user is the dentist, the lab, the patient, everybody benefits. And so, um, I think you're you, everybody benefits, and so, um, I think you're, you're really on a great path and you're influencing our field in a really strong way.

Dr. Sven Bone: 41:52

Well, thanks yeah.

Dr. Tyler Tolbert: 41:54

Awesome, um, so this would not be the fixed podcast if I didn't ask this question. So, um, I do it for everybody. So what is your most controversial opinion in full arch dentistry?

Dr. Sven Bone: 42:04

Oh, my most controversial opinion, uh's see here.

Dr. Tyler Tolbert: 42:13

You got to upset somebody.

Dr. Sven Bone: 42:15

Right, I know, I think well, you know, I think the I think we need to. I think where I'd like to see things improve is I feel like there's a lot of noise in the like on social media and things like that. As far as you know, marketing and KOLs and things like that, and essentially we're kind of like I'd like to see more objectivity in the industry and I do feel like we're manipulated too much, like basically, there's a lot of manipulation going on and I'd like to see a little more facts like a little more like real, rigorous facts and less like nonsense, you know.

Dr. Tyler Tolbert: 43:16

I think that's fantastic and it shouldn't be a controversial opinion, but I think it is. Um, you know, I think we live in a in a social media era, right, and you know everyone is just trying to uh, make noise, uh, for the sake of getting listened to. Um, you know, I I play somewhat of a part in that. I have a podcast I try to promote and I want people to hear it. But I think for us, we want to bring that objectivity and we're a sponsored show and we talk to people about their products and their services. But ultimately, we do have to hold ourselves to a certain amount of rigor and show data and show more than just a hand-waving argument as to why something works and why other things don't. And I think that's really important. And you know our mission here is just to help people make educated decisions and I think you know that should be a standard throughout the industry.

Dr. Sven Bone: 44:02

So yeah, I think it's just. It's just the nature of the of the industry right now. It's like how things, how deals get done, how things are, are you know how, how things are progressed, like we we, if we didn't have that, we wouldn't be where we are today. But that doesn't mean that we can't improve or get better, you know, and and so. So I think we put a lot of weight on on like opinions and and I think we're going to get, I believe that we're going to those opinions are going to matter, those people with high EQs, huge social networks, things like that they are definitely going to be, always be an important player.

Dr. Sven Bone: 44:42

Yeah, you know that's that that is going to be important, but but at the same time, I think we can. Manufacturers, the you know, innovators their responsibility is to supply them with real, you know, valid data so that we can, all you know, get to from A to B you know, in the right way. And so it just depends on the agenda Right. Yeah, so I don't know if that's that very controversial because honestly it's kind of like it's a fact. That's just the way it is, yeah.

Dr. Tyler Tolbert: 45:21

Yeah, yeah, I mean, it's the way it should be, and maybe, uh, maybe, instead of being a key opinion leader, we should try to be a key objectivity leader. We should, we should bring data.

Dr. Sven Bone: 45:30

Yeah, I mean it always comes down to opinion, but but, at the same time, you know, I think that, like you know, um, like I like, if we're talking about like a screw or something like that, right, okay, like who's going to be a great opinion leader for a screw, right?

Dr. Tyler Tolbert: 45:48

It's just the guy that screws the stuff in.

Dr. Sven Bone: 45:51

Right, right, yeah, right, I would engineer over like I would that's who I would go to, like like that I would trust an engineer over um over. You know somebody that just like uses them you know, on a daily basis, like like basis, like like they they may or may. I mean because we are our opinions, like like we. We aren't exactly the best witnesses, um you know, of of whether something is good or whether something is bad, it's just it goes back to like a happy patient isn't necessarily the best judge of how well you did.

Dr. Tyler Tolbert: 46:33

Yeah, you know, a five-star Google review does not tell you how your screw performed. No, it doesn't. Yeah.

Dr. Sven Bone: 46:39

And and and so so we, I think we need to be a little more uh, you know, you know objective about, about, about how how we assess things.

Dr. Tyler Tolbert: 46:50

Yeah, no, I agree, and I think that you know, when we were talking at the symposium, you know you kept bringing up about standards and other industries, right, and it's like, yeah, we're, we're inventing screws and like there's all these new patents coming out with like different, you know, dental screws, different implants, all these things, but the screw in its form has existed for a very long time before modern dentistry ever existed, right, and there's people that have really put a lot of time and work and research into screw design. So there's a lot of things that can be learned that have already been discovered and we don't need to reinvent the wheel. Yeah, and that that was kind of a Eureka moment for me and I really appreciated that. You know you're bringing that sort of context into into dentistry and raising that standard.

Dr. Sven Bone: 47:32

Yeah, yeah, and I mean, that's just one, that's just one.

Dr. Tyler Tolbert: 47:33

you know thing, it's a small piece of it.

Dr. Sven Bone: 47:34

Yeah, but there's so many, you know, there's so many different things and and and also, you know, I think, true, the. I think it's also really important to surround yourself with mentors, like as you go in your career, I think. I think it's really critical, critical to um we also there's a lot of bro science out there, right.

Dr. Tyler Tolbert: 48:00

I mean, there's a ton of it right, and and so.

Dr. Sven Bone: 48:03

So, like I think, as you move along in your career, I think you want to to, you know, get those mentors that have more sophisticated models that you can learn from, and feedback as you grow and learn, and, and, and I think I think, like you know, get we. We tend to like huddle in our own little groups and we stay there and that's how you get stuck right and so so.

Dr. Sven Bone: 48:32

So I think it's really important to reach out to you know, like a, a surgeon that like sews heads together yeah, yeah you know, like, like, get, get those mentors that have, um, you know, a lot of, uh, different experiences than yourself, and, and, and. As soon as you feel comfortable in your group, it's time to move on.

Dr. Tyler Tolbert: 48:56

I like that.

Dr. Sven Bone: 48:57

No, that's good.

Dr. Tyler Tolbert: 48:58

That's good, yeah, and I think too is, you know, I've always kind of you know I can I can kind of tell the history of my own career for the people that I looked up to Right, and I think that if you, if you only look to the people that look how you want to look right, the people that you're trying to model yourself after, um, that that's not always the best way to go about it, because you need to kind of pick apart all the different components of what you want to be.

Dr. Tyler Tolbert: 49:21

Maybe you want to be clinically excellent, maybe you want to be great in business, you want to be great in marketing. If you just model all of those things off that one person, you're going to be a little bit limited, right? You need to pick and choose from the people that do really well at all of those things, and then you can be a composite of those things and that's what can make you, um, you know, truly successful, because you're drawing from best practices of all of those things, cause no one is is is really the master of all trades.

Dr. Sven Bone: 49:43

Yeah, I mean and and also, and also specialize, like, like focus on, on what you on, on, on, you Like focus on what you.

Dr. Sven Bone: 49:50

You will be a master of none if you don't really dedicate your attention and focus onto a few things. And I think, at least for me, I'm happier if I really focus on a few things. Like I don't do veneer, like I'm not interested in cosmetic work. I love taking a hot mess and making it, you know, and fixing it all. It's awesome. You know that. That's. That's my focus. I the they have the biggest impact on patients lives and and uh, and so I have tons of stories where that you know, patients have um been totally changed, like their careers and because they were a hot mess and we got them all straightened up and and so. So it's, it's a, it's the most rewarding thing for me and but yeah, I'm not doing there's. I say no to a lot of things, you know you have to get used to you know if you, if you want to.

Dr. Sven Bone: 50:49

At some point every dentist needs to say no. They need to learn how to do that.

Dr. Tyler Tolbert: 50:55

Yeah, no, that's really good, that's really good. Yeah, no, I think that's a great closing note for us. Is, you know, figuring out how to dive deep and become, you know, a master of something? Right, figure out what it is that you really want to go deep on and get really into it, and that's, you know. That's something that inspired us to do this show, and it inspires us to bring people like yourself on it, and we're just so honored that you're able to spare your time.

Dr. Sven Bone: 51:17

Well thanks, yeah, no, it's been great. It's good conversations. I'm always up for that.

Dr. Tyler Tolbert: 51:22

Awesome, awesome. Well, this episode will probably be airing right around the time that you're opening up a distribution of the Badger Screw, so hopefully we can get that synchronized pretty good. And yeah, I'd just like to reiterate thank you so much for bringing all your knowledge and expertise into this conversation and we look forward to continuing the conversation later. Yeah, I hope it was helpful. I really do, I'm certain it was. It helped me, if nothing else. But I think our audience is really going to like it Okay good deal man.

Dr. Sven Bone: 51:51

Thanks man, All right, Take care.