The Fixed Podcast

Behind the Arch: A Deep Dive with Dr. Nestor Marquez (Dr. Ness): Part 1

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What happens when Instagram perfection meets clinical reality? Dr. Nestor Marquez pulls back the curtain on full-arch implant dentistry in this candid conversation that every clinician needs to hear.

Practicing in the unique dental tourism hub of "Molar City" (Los Algodones, Mexico) while living just across the border in Yuma, Arizona, Dr. Marquez shares his unconventional journey from failed dental student and aspiring musician to respected implant clinician. With disarming honesty, he reveals how his father's tough love redirected his path toward dentistry—a decision that ultimately led to his passion for complex implant rehabilitation.

The heart of this discussion centers on proper clinical education in today's social media-driven landscape. Dr. Marquez challenges the contemporary rush toward advanced techniques, describing how he watched over 100 surgeries before attempting his first case and completed 500-600 traditional all-on-four cases before incorporating pterygoid implants. This measured approach contrasts sharply with clinicians who attempt complex techniques after a single weekend course.

Perhaps most valuable is Dr. Marquez's transparency about complications. "The gods of full arch have complications," he reveals, describing how even the most respected clinicians privately seek advice when cases go wrong. This reality check serves as a powerful antidote to the curated perfection of dental Instagram, where clinicians showcase their successes while keeping failures private. His advice on patient communication—never guaranteeing specific outcomes—stems from hard-earned experience.

Beyond technical skills, Dr. Marquez emphasizes the psychological components of implant dentistry: managing patient expectations, maintaining perspective, and knowing when personal factors might compromise clinical judgment. These human elements, often overlooked in formal education, prove essential for long-term success.

Whether you're an experienced implantologist or just beginning your journey, this conversation offers rare insights into the realities of full-arch implant treatment. Follow Dr. Nestor Marquez on Instagram (@dr_nes) for his exceptional clinical documentation and educational content that brings transparency to this complex field.

Speaker 1:

My name is Dr Tyler Tolbert and I'm Dr Soren Papi, and you're listening to the Fix Podcast, your source for all things implant dentistry. Hello and welcome back to the Fix Podcast. I'm super excited. We have a very charismatic and capable guest today who has graced us with a beautiful cowboy hat, which I believe he threw in last minute, but we're super appreciative of that. We're also both sporting some neon signs, you know, repping our sets and stuff like that. So today we have on Dr Nestor Marquez.

Speaker 1:

I had the pleasure of meeting him fairly recently. It was at the last. I think it was the Orca. No, no, it was Orca. I believe we met at Orca Most recently. That was the Orca Symposium in Vegas. Very, very cool, great session, by the way, definitely one of the most informative symposiums I've been in recent memory and definitely had some heavy hitters for the Full Arch game. I think that as far as implant-focused symposiums go, full Arch definitely gets talked about a lot, but there's a big blend of what implants look like in different dental practices. But this was really specific to full arch and there were just a lot of heavy hitters there and it was really awesome meeting you, so we just had to get you on the show, and it took us a little bit of time to coordinate schedules, but it's finally happening and I couldn't be more excited.

Speaker 2:

It wasn't all my fault. All the time man.

Speaker 1:

Oh, it was totally my fault.

Speaker 2:

I take full accountability for this. Yeah, absolutely, it's, it's good. I, I, um, I'm happy that you. You know, I remember in vegas you were like, hey, man, would you mind being on the podcast? I was like, dude, I love it, we'll be in touch. I was with my wife that night, I remember, and so, like the rest, is history. Now it's been a couple months and here we are.

Speaker 1:

Man, thanks for inviting me no for sure, man, I've been really excited to have you on and I know Soren was really happy to, really excited to interview as well, but he's got a busy schedule too and we couldn't quite make it happen, so I know he's got some FOMO right now.

Speaker 1:

But yeah, man, I've been a huge fan of your work. If you guys don't follow Dr Ness on Instagram, you've really got to see some of his clinical photography and what he's putting out there Just some of the cleanest, most well-documented full arch cases you'll find anywhere. And he does these really cool things where he draws on the clinical photos, talks about the techniques that were done. Little nuances there that maybe not everyone can really pick up, but if you know what to look for, everything is just clinically executed so beautifully. He does a really great job of documenting that and sharing that. But before I get you know too too into you know blowing smoke, dr Marquez, if you could just kind of just do us the pleasure of kind of just doing a brief intro of you know who you are, what your background is, your journey into dentistry, implant dentistry, all that good stuff.

Speaker 2:

Cool Thanks, man Well. Dentistry, implant dentistry, all that good stuff cool thanks, man well. First of all, thanks for all the accolades or you know, thanks thanks for everything. I uh, I instagram just was a thing that I started, probably about seven years ago, you know, and it was just literally. I opened a different instagram, uh, because my wife was like nestor, you really shouldn't post gross like, and I think I was posting like wisdom teeth.

Speaker 2:

Back then, you know like gross things on instagram like yeah, my mom, uh, my mother-in-law at the time, not at the time, she's still my mother-in-law. She would be like oh, like, I don't know, I'm gonna unfollow nes yeah I opened a specific instagram.

Speaker 2:

I thought of dr nes, and then yeah, and then yeah, that that kind of started things out. Instagram wise, you know, uh, school wise man I to. I did all my schooling in Mexico, close to Mexico City. I was born and raised in Arizona but I was as I'm sure people that know me know I was a bad teenager. Not that I'm completely good now, but I'm better.

Speaker 1:

You were a bad teenager Now. You're just a bad adult Now.

Speaker 2:

I'm just a bad adult. My mom was like you know what Reverse American dream guys, we are leaving the USA and going to her homeland. You know, which is like Mexico City area, cool. I was like oh bummer, you know like what we're leaving? Girlfriend, friends, almost gangs, or whatever. It was back then.

Speaker 2:

And reverse american dream. We, we ended up straightening our paths over there actually, and uh, and I joined a church band, started going to church, I got better friends, I guess not, I guess I know. And then it was time for for dental school and and, uh, at the time I was was like a heavy, heavy musician, like I had longer hair than I have now. It was kind of like, you know, I wanted to be Ringo Starr. You know that, look, you know where you're, just like you're a hippie in dental school. It was first year dental school and I was like actually this is something that I probably haven't said before I flunked first year of dental school because I was not like there mentally nice, that's a badge of honor, man man.

Speaker 2:

My dad was like hey, nestor, like I don't know. I was like dad, it's because I think I'm gonna be a musician and we're gonna tour the world and I'm gonna. He's like nah, man, I don't think you are man, I think I need you to do this. You know, I feel like that's one of the hardest like things my dad has done to me. He's like you're in a dentist.

Speaker 2:

I think you're gonna. You've always kind of wanted dentistry and I kind of did. You know, I have an uncle who, who, um, is a dentist, was a dentist and through him I was like, oh, you know what, I'd like to be a dentist someday. And yeah yeah, that turned into to me leaving music behind. I dropped out of a music school that I was going to at the moment, like for classical guitar wow, awesome music school thing like professional musical, you know yeah music and uh, and from there on, on man, it was like something, something switched in me.

Speaker 2:

You know, I became a leader, group leader and um, yeah, from there my grades started going up. And you, you better bet man, probably just like you as soon as we started pulling teeth, I was like okay, oh, okay. You know what I'm saying, Like whoa, yeah, okay, you know.

Speaker 1:

Yeah, yeah, yeah, I can be a rock star of a different kind.

Speaker 2:

Somehow like that, you know. And then, yeah, I left, I did my internship. Actually, this is how I started liking surgical stuff in a hospital with a maxillofacial surgeon, dr Arturo, and like he taught me so many things Not full arch, though. Nothing is full arch really in the outer world, so to say, of dentistry.

Speaker 1:

Yeah.

Speaker 2:

And then, yeah, I did internship. I came back to the US. I didn't have money whatsoever at all. So I remember I got a job at a cooler like a cooling place for lettuce, because here in arizona, where I am at, oh sure, yuma arizona a lot of like lettuce produce and stuff.

Speaker 2:

So I got a job there. Three months later I quit the job. I went to church one sunday morning for the first time and the pastor was like, hey, why don't you turn around and greet your neighbor? You know, I turn around, I see the most beautiful woman I'd ever seen, which is my wife now. And I was like, oh, I need to come back here. You know, I met my wife. I can talk about love stories and stuff, you know. But then what happened is I started seeing that the type of I'm in Mexico, by the way, like I work in Mexico, but I live in the US.

Speaker 2:

It's a really tricky thing there. I live in Yuma Arizona, but 10 minutes from Yuma Arizona, 10 minutes literally. That's my commute Los Algodones, baja California, mexico, also known as Molar City. So 10 minutes every day back and forth. What happened is I started noticing that the patients that came in to look for work were needing implants, you know, like dental implants and I was like, oh man, like okay, like single implants, cool. But then we would have these cases that would come and be like, hey, you know, you guys do the all-on-four, and I was like, ooh, that just sounds like hard dentistry, you know.

Speaker 1:

Like well no we don't.

Speaker 2:

But what we usually do is we call somebody in and they come in and help us do the surgeries, you know or I guess we would say we did, but that it was a specialist.

Speaker 1:

Yeah, you're right, pharmadon yeah.

Speaker 2:

I didn't send them out. I had that specialist come into my clinic here.

Speaker 1:

Right.

Speaker 2:

So, anyways, that I started noticing that, the need for that you know of American people come into Mexico for more economic.

Speaker 1:

Yeah, so was that mostly American people coming South of the border, or was it?

Speaker 2:

To this day it's still 95, 95 of our patients are american. Coming south dental tourism, you know which? Oh man, that topic is big because you know of course we. We call it the race down uh yeah, of course, prices in the us are dropping because of it and, uh, what they don't the us doesn't see is mexico still hasn't played that card. But Mexico can also drop prices a lot lower. You know, Like what are we going to do?

Speaker 1:

Yeah.

Speaker 2:

How low is too low, you know?

Speaker 1:

Where is the bottom? Yeah, right, where is the bottom?

Speaker 2:

Yeah, because we're talking about different countries, different you know currencies, so a lot of you can definitely do an arch with bad materials for a lot cheaper here in Mexico. That's not something we do, you know. We we stick to high standards, we use good brands. We use everything. But there is that world of like oh, let me get made in China stuff you know, and, and then it goes, yeah.

Speaker 1:

So and how was a consumer to know the difference? Right Like it's just amnesty for you to be using good stuff, but you don't have to you know Exactly, man, exactly, unless.

Speaker 2:

You want See, my view of that is as a Mexican American. I was born in the US but you know for Mexican parents. Of course you got to make sure that things are done correctly here in Mexico, because you hear the horror stories.

Speaker 2:

They're not all fake, there's a lot of there's a stigma yeah, there's a stigma, you know, like, oh, don't go to Mexico, you know, but I get it, you know. I mean there's good and bad everywhere, but maybe there's more bad here than there is over there. I'm not going to be that person, but we want to race that bar to make sure that the standard here in Mexico is up to date, you know. Anyways, yeah, where was I? Yeah.

Speaker 1:

So I mean you were just talking about how you know you were bringing in a specialist to get all in for done, and then I'm assuming of course there was a transition doing it yourself.

Speaker 2:

Sure, yeah, so, and I'm sure this might be a question in the podcast later. But schooling wise implant dentistry you know I went, I went through some post degrees here in Mexico for implant dentistry. You know I never did maxillofacial surgery, I never did perio, I did. There's like little post degrees here in Mexico for implantology okay happened. What happened next was I got a mentor. That did.

Speaker 2:

Full Arch Because a lot of people ask me, like Nesser, what's the best Full Arch school out there? And now I have an opinion. But I think I did it the right way. And the right way, if you ask me, is not through CE, which is hard, and I have an opinion on that man. To me it was a mentor that lives and works in the same town that I do. Why is that different than saying, oh, dr Nestor is your mentor, although he's a thousand miles?

Speaker 1:

away Somewhere else yeah.

Speaker 2:

Like sure, there's the mentorship that counts, like that, and you'd hop on calls and stuff. But what I did and I think that I did right is I was bugging Dr Ever, who we're going to give a course with him later on. Uh, this year, this one of my first mentors Um, I was bugging him daily. Man, when I started my clinic, my practice I had three to four patients a week, so like I had a lot of free time and he took the best that like.

Speaker 2:

I was like hey, ever like, do you mind if I come over to your office man? He's like no, I'm going to be doing full arch. You know, I'm like that's what I want to see. You know, and I was there, I was there like, and I kid you not, I probably watched like a hundred surgeries, and a hundred is a lot, man, if you think about-.

Speaker 1:

To watch, yeah.

Speaker 2:

To watch. It's a lot, you know, With me just being there. I was just there. I had nothing to do so I was there and of course, I saw complications. I saw failed implants, I saw different approaches, I saw complicated extractions. I saw a broken buccal bone. I saw everything extractions I saw a broken buckle bone. I saw everything you know, and it was I wasn't really practicing, though.

Speaker 2:

But, here again. One of our problems these days is that I see a lot is you take a CE course and you go right to doing pterygoids or psychos, or you know like all I did man was all on four or all I saw was all on four. That he wasn't even doing pterygoids at the time. It was all on four, simple, two straight, two tilted. You know maybe he did an M every now and then and I was like, okay, you know like wow, repeat. Okay, you know like wow, repeat, repeat, repeat, repeat. And I was like, yeah, and after me doing some studying, after me having taken some you know diplomas on implantology and stuff, I said you know what I'm going to start with overdentures. I'm sorry, man, like it almost sounds like oh, it's lame, but I think I did it the right way and that's why you?

Speaker 2:

know overdentures and I started doing two straight implants, mandibular and I did do two upper implants for overdenture and I found out what that was later, you know.

Speaker 1:

At least you figured it out, man.

Speaker 2:

I did.

Speaker 1:

Some people are still doing it or not.

Speaker 2:

Yeah, and my mentor was like, hey, Nestor, I wouldn't do that again, you know. But it was that separation from mentor and like, oh, I'm going to do it after watching 100 surgeries. But coming back to my mentor, like, hey, man, why did two single implants fail on top? You know he's like, oh, have you ever seen me do that, Nestor? I?

Speaker 2:

was like no, but I've was kind of there, you know, I was like hey, have you ever had this happen? You know, hey, have you ever had a patient get mad at you for this? Oh, nestor, like you want to talk about patient communication and dealing with patients, cause that's a whole different book, yeah. Yeah, somehow separate it you know, you think, ce I'm a bad-ass surgeon? Separate it. You know, you think CE I'm a badass surgeon? Bring the work. Oh man, I feel like we almost have to go through psychology school sometimes, you know.

Speaker 1:

Yeah, we do, we do yeah.

Speaker 2:

So, anyways, I started having problems, but I started doing more full arch All on force. Then I started to all on force Buried implants, I would not load.

Speaker 1:

No, loading Okay.

Speaker 2:

No loading force buried implants. I would not load, no loading.

Speaker 1:

Okay, no loading.

Speaker 2:

I was scared, I was like oh man, I don't know, like that seems like it's got torque. But you know, understanding the I'd already seen it I understood the principles, you know, the 120 threshold, I, I, I knew, but I was scared to make the jump, you know. But it made me pace myself.

Speaker 2:

Take my time to get to where I am right now. Then I started loading, you know, and then me. Don't think I I I'm not saying continuing education is good like while I was loading and and doing all these things, I was learning. I was reading books. I was going to courses learning about it, but it was for me pacing myself like I'm going to do this. I'm more comfortable with this. My stitches are not opening up as much anymore, you know, or my you know, or I have a good communication with my lab.

Speaker 2:

Now, now I'll do this, now I'll do that, now I'll do that. Then I started doing immediate load this is probably like six or seven years ago and we started loading all the cases and I started finding out what cluster failures were, you know, and I started finding out how to deal with patients in a cluster failure and having to call in a specialist to do psychos.

Speaker 1:

Yeah.

Speaker 2:

And like that's what nobody tells you these days is.

Speaker 1:

Right.

Speaker 2:

I always call it. I always I used to have a hashtag that said full arches of world, like it's not just open place an implant or four implants, and wait, there's so much more. You know, there's the patient communication.

Speaker 2:

There's the proper prosthetic design, the good torque, the good implant design, the techniques. What if this goes wrong? It's so much like that's why we feel nowadays that implant, that full arch dentistry, should be kind of like a post degree of itself, Like it should have its own little thing, because it's so much, you know, it's, it's the most aggressive thing we do, as as in dentistry. You know, it's not a crown, a full mouth rehab, it's full arch.

Speaker 1:

For sure.

Speaker 2:

So, anyway, man, yeah, that's um, that's a little bit of of the upbringing you know so far. Um, my mentor was always there with me. I wasn't traveling, I wasn't calling him. I was like, hey, man, do you mind if I do you mind coming over? Actually, he would come over once or twice, he's done that, that's great. Imagine doing that instead of just we're afraid of what do you call it? He's your. Competencia means like because you're in the same town and you guys are competing. We don't want to train our competition.

Speaker 1:

You're worried about scarcity and things like that.

Speaker 2:

Something like that. So, like, there's even people these days who are like, oh shoot, I got to train that guy, but he's in my same city. I should not do that. Yeah, that's a way of thinking that we never adopted and it was because my mentor was never like that with me, although I work in the same town, he does, and I do full arches that he could have done. You know, that's not the mindset man. You know, yeah, and I have the same mindset. There's people here in town these days that are like hey, dr Nestor, like can I come watch a surgery? I'm like text me Monday, I'll tell you when the surgeries are this week, get over here. And there's people watching my surgeries, man, for free, you know.

Speaker 2:

Although, there's people that pay for that. There's people that are here in town that I want to bless and be like. You need to do this the same way. Come watch it, you know. But it's not because we're in the same place. It's because we don't have that mindset of like I need to be the best and like there's nobody that can be like me.

Speaker 2:

Like, if they learn it from you. They're going to learn it from somebody else, you know they're still going to learn it. People are still going to do cycles, whether and they're probably going to mess up five cycles if you don't teach them the right way or you don't make a comment Right.

Speaker 1:

Yeah.

Speaker 2:

And then they'll find out the right way.

Speaker 2:

And it's not going to be you who helped out, you know, let's just help each other, so that's that's how I got to to basically where I am, and then I started meeting people through instagram and social media, got invited places. Uh, I started making more mentors. Now, the type of mentorship that I needed wasn't in person, because I could also already do full arch. I needed like little tips and little phone calls and little. You know, I started doing pterygoids because of juan gonzalez. He let me come to texas a couple years ago. I was like dude, like pterygoids, everybody's doing them, what's up. You know, he shows me, I see him do it one time. By that time, man, I had already placed thousands not thousands maybe, but I probably already done like six or 700 arches without pterygoids.

Speaker 1:

Yeah.

Speaker 2:

Before I did pterygoids guys listen to that I probably did 500, 600 arches. That's a simple all on force before pterygoids. Why is that funny nowadays? Because everybody's starting up and it's like yeah, I'm doing pterygoids already, like yeah, there's like a new standard now.

Speaker 1:

Yeah.

Speaker 2:

That's the new standard, like if you're doing full arches and not pterigoids, you're really not that good like and most of the cases that I'd done man successful cases with four. Yeah, of course, yeah, yeah, um, anyways, I I saw juan do it one time and I was like, oh, thanks, one, like I get it, I get it. He, we went through anatomy one time.

Speaker 2:

He explained it, you know, and that's a mentor to me and then we have so many stories of doing surgery together nowadays where he still saves my butt, that that you know. Respect him whom respect is due. You know, on little details that I'm just like. There's a saying that says in Spanish here it goes. It says, and it translates to the devil knows more because he's old than because he's the devil, you know and. I've always attributed that to Juan Gonzalez, because it's a experience man.

Speaker 2:

That's the name of the game is experience. Everything is easy and full arch. It's simple if you think about it. Tyler, come on if you think about it, it's, it's easy you open a flap oh yeah, teeth, you cut the bone, you drill, you close it and take a cool instagram picture.

Speaker 2:

You feel like a badass it's the same dance every time it's the same dance every time until one little thing makes it not the same dance every time. It's the same dance every time until one little thing makes it not the same dance, where you step on the girl's feet, you know and everything, and she screams and like it's not the same dance. Then yeah, and you're freaking out and you start getting nervous and you don't dance the same. Those are the. That's what experience gives you, you know, and that's where mentors come in.

Speaker 2:

You know um. One other huge thing there that I would add to that is like we don't, we seem to Instagram can be detrimental in the way that we post so much and we get this amazing feedback from people that are our friends or people that –'s. There's a lot of fan, fan groups out there Sort of say you're the best goats, greatest of all time, bro, you're killing it, you're the best in the industry. You know that when something bad happens cause your ego got in the way already, it's hard to reach out to people and be like bro, what the hell did I do wrong here? So you're alone.

Speaker 2:

you know, ranger, now you're like by yourself, because it's embarrassing to be like guys.

Speaker 1:

What did I do wrong?

Speaker 2:

here, you know, don't be that person. Anyways, man ask me a question or something. I need to stop talking.

Speaker 1:

No, no, this is great. I'm, I'm, I'm taking notes as I go, like I don't like to disrupt your flow. No, I think that you know a few things that you touched on that were really valuable. I'm going to go all the way back to. You know, like a proper way to get into full arch you talked about, you know you have some opinions on, you know, great institutions to go through in terms of your schooling, in terms of your CE. All those are, of course, necessary and you should do them. But you talked about, you know, the, the benefits of finding not just a mentor but a local mentor. Someone that you can be over the shoulder with is going to be locally there to support you, and that's a huge thing. And and that's that's what I had, um, you know, for myself, you know my entry into full arch was absolutely mentored. It was, you know, my hand was held um, for my first, you know, six months to a year or so, even though I even though I still kind of did it at light speed, I still had mentors. You have to have that, and I totally agree with needing to have that abundance mentality and that's really what's pushed our field forward. It's not, you know a few like really solid clinicians, just being protective of what they do. It's that willingness to share and I think by doing that, that's what's helped you elevate yourself and in terms of your Full Arch reputation abroad and it's opened up so many doors for you just by being willing to help other people. And you know, full Arch is still very much a niche thing. It's absolutely exploded.

Speaker 1:

But I think that there's a ton of really bad Full Arch work being done and it's necessary for the people who are doing it well and at a high clinical standard, who have seen the long-term associated with good versus bad cases, to help spread. You know, you know what it really takes to accomplish these cases, because the problem with full arch is there's a lot of short-term reward in it. There's a lot of long-term consequences, and so I think that that's something that's really fueled that kind of race to the bottom is everyone's trying to do cheaper arches. They're trying to spring, you know they're. They're swinging for home runs when a single would do, you know, and they're taking on complex cases cause they see it all over Instagram and you know, maybe they accomplish it. They get something that screws in and they feel like they did something, only to find out later on that there were so many nuances they missed, there were so many problems they haven't run into yet that they're going to find later. And you know they're again racing to the bottom, just setting themselves up for long-term failure.

Speaker 1:

And it's so important for people like yourself that have been in the game longer to help really show like hey, this is why we're saying you need to walk into this and you need to have mentors and you need to have people you can bounce off of. And I totally agree with the bit about ego is like most of the stuff I share, it's the better cases I've done. There's, there's no question about it. Like you're definitely seeing like the top. You know 50 percentile of what I do. There's another 50 percentile that I'm not as quick to share I would, but you know it's. It's like you. You want the flame emoji, you do Right, you want the flame emoji. You do Um and uh. You know it's very rewarding and I think that when you're recording yourself and you're posting it and you're sharing it, it's cool to have all that positive feedback. But at the same time it breeds hubris and it makes us a little more closeted about where we fall short and trying to learn from that.

Speaker 1:

And it's so important to just be open-minded to getting criticism for people that have had more time in the chair and have been able to the long-term follow-up on these cases.

Speaker 1:

You know one of my personal mentors now that I turn to a lot is Dr Clark Damon. So he, he really converted myself and Soren into placing a lot more territory ways to provide additional support and both of us had several hundred arches of just traditional on four under our belts before we went to his courses and started doing that. And you know it's so great because every time I have a case I'm like super proud of it. I'm like, oh man, I absolutely nailed this. I'm going to show this to Clark without fail. There's there's immediate feedback and it's not. It's not badgering me, he's just telling me you should have done this, you should have done that, look out for this next time. This is what's going to happen. And, like, I get that immediate negative feedback. That kind of balances out all the other fire emojis and stuff and I learned from it and it makes you a better clinician and you have to be willing to be humbled to get better at this. You can't just live in an echo chamber of positivity.

Speaker 2:

I love that we say here in Mexico el que se aguita pierde Him who like feels bad loses. You know what I'm saying? It's very easy everybody likes to just be praised over something that you're like dude, at least look at the badass picture I took, you know, but like we don't need praise man like we don't need it, if you really want yeah in this for long term and if you want to be a happy mental person, you want your cases to be successful, not your pictures. Who cares about?

Speaker 2:

the picture nobody sees of that beautiful all on six became a cluster failure.

Speaker 1:

You're not gonna post yeah, like right, I'm just showing you the post-op.

Speaker 2:

Yeah just showing you the post-op picture like, or the before they leave the office. Yeah, nobody knows if a patient became blue and swollen or is calling oh my god telling you you're a prick, for you know, yeah, oh, every time, yeah, all the time. Nobody tells you that, yeah.

Speaker 1:

Some of my, some of my like proudest cases, even some that I've put up recently, where people are like, wow, fantastic, looks really good and I, you know, surgically it was a great case. You know. They don't see the text I get from the patient the next day where they just look like they were just mauled by the bill of earth event, right, and I don't post it either. You know, uh, but it totally happens, man. I mean it's, it's, uh, it's, it's a, it's a tough world and I think that you know, when you have that personal mentorship, you can see the more real side of it, the hard part of it, the part that you know even keeps the best clinicians up at night, like that exists and it's it's, you know, it's prevalent. We don, we don't talk about it.

Speaker 2:

A lot, I, I, I, when I give a course, I always say that and it's kind of to break the ice, you know, because I'm fortunate to be a teacher to general dentist, maxillofacial surgeons, periodontists like, and breaking the ice with them is like all right guys, listen, I got friends you know, I don't have enemies, or I don't think so, but I got friends, and some of my friends, I say, are people you look up to, and and I might be someone you look up to, but I got friends that are, like you know, mortals, dr Ness, mortals, gods, you know.

Speaker 2:

you know what I'm saying yeah oh that, and I'm in groups with them, sometimes on WhatsApp or something. Yeah, and guess what they have complications.

Speaker 1:

Yeah.

Speaker 2:

You're saying the gods of full arch have complications. Absolutely you bet, and sometimes the gods of full arch will text in the group and be like hey guys, send your prayers. You know this patient's having this complication. We're not sure exactly what's going on. If it's a medication they're taking, if it's this, send your prayers, boys.

Speaker 1:

And it's like wait a minute, just cross your fingers.

Speaker 2:

Prayers, you know, so like that should humble anybody man Like whether you're the best maxillofacial surgeon from your class or you feel like you've done 300, 400 arches and you're a pro. It should humble you enough to be like okay, so like we're all in the same boat together. You know, sure, there's little stars and like there's achilles in the boat. You know there's. There's the hierarchies.

Speaker 1:

You know there's, there's a badass yeah but, but we're learning and we're sharing and we're just reminding you, like no need to play the game of of the king of full arches, you know like yeah yeah, yeah, no, I, I totally agree and I I think that's a a really refreshing note and even me personally, like I, I kind of need that kind of reminder every now and then, because it's so easy to just, you know, put people on a pedestal and just assume that everything they touch is gold and, uh, it's not true. I so much of what really occupies like the busy, successful surgeons mind is their complications, like that's what's actually going on in their minds, what the hell they're going to do about this case or that case. They're not even thinking about the one they posted. You know, like man, I got some other shit going on back here. You know that's got me diving back in textbooks trying to figure out where to go from here, you know. So, yeah, I mean, I think that's a, that's a really good, you know, dose of of reality.

Speaker 1:

And you know, one thing we try to do with the podcast too is is we, we want to show the good and the bad. We want to show where things go wrong and where we get humbled, because that's that's where learning happens. You know, when the case goes super smooth, like I had one yesterday, that was just great, I mean, it was like a double. I posted it. It was a double. I did it in like an hour and 45 minutes. It was six over six. It was just clean. Pretty Everything was right where it needed to be, but I learned nothing. You know, like I got nothing from it I'm not going to grow from, and so you know, where I'm at is really just an accumulation of all the cases that that made me sweat and make me question myself. It's not the ones where I pat myself on the back and I go share on Instagram and be like hey, look what I did.

Speaker 2:

You know, yeah, yeah. The case is that you're like when did I decide? Why did I decide to get into full arched industry again, you know? Remind me why I started doing this, for why, why, I think it's a good idea, you know? Yeah, yeah, of course I've had the case where you're just like this, you know, like yeah.

Speaker 1:

Right.

Speaker 2:

You're doing the upper arch. The patient is either general or intubated or IV.

Speaker 1:

Yeah, and you're like I can't do it man, I can't do it.

Speaker 2:

Call somebody, man. I've called my brother downstairs and I'm like dude, I'm done. Man, I don't want to do this case. We'll do the upper and we'll do the lower in a month or so. And he's like that's true, dude, dude, take a break. Man, come here, take my gloves off. And he's like what's going on, you know, and we forget sometimes. I'm like sometimes it's not even just a surgery. You might have some stuff going on back at home.

Speaker 2:

You might have that life is life, you know, and I'm like, yeah, thanks bro, you finished the case and that actually lets you that. That's a growth.

Speaker 1:

I was like yeah, I can conquer the emotions that I'm having during a complicated full arch surgery, to you know anyways show up, you have to have a good night's sleep, you have to be adequately caffeinated or whatever it is that you pregame with. You know, and yeah, I mean you can't, you can't afford to give a patient. You know less than your best and they've invested in this and you know there's a lot of things that can come about. If you just you said it's really not that complicated. It's the part that is so immeasurable and can't be shown in terms of CE hours or grades or diplomas or whatever you got. It's just that stomach lining to perform when maybe you're not at your best.

Speaker 2:

Exactly, man, exactly, that's something not so spoken of. That is necessary when I start, and maybe we'll talk about ways of the arches later. But when I start my course I have a special portion, the first portion, and I say, hey guys, we'll talk about arches. This first portion is not exactly about arches. It's about a little bit about mental health, a little bit about communication with the patient.

Speaker 2:

what you should say to the patient what you shouldn't say to the patient, why you say certain things to the patient it's. I have a friend that says hey, man, teeth are easy. Teeth are easy. Full arches yeah, it's, who holds the full arch. That's hard, you know. Right, you're placing it to. That's hard yeah yeah, it's, it's, it's reading into the patient. You know those that um what is house?

Speaker 1:

or millis house classification, remember that uh I think I know what you're talking about the patients that were becoming oh, like the exacting and the uh, all the different. Yeah, yeah, those guys, yeah sure, those guys, that's yeah that was written 1950 or something.

Speaker 2:

I'm like. Doctors have struggled with patients that are in the edentulous world for many years. You know, and and back then 1950s they were like you should not get into a fight, get into it with this patient. You know that one needs psychological evaluation, which is not something we really do.

Speaker 1:

No, I've never sent anybody out for a psyche ball.

Speaker 2:

I looks like a nice person. Sure, let's do the full arch. You know, three years later, like God, help me.

Speaker 1:

Yeah, yeah, and you know it's like this is a complex population. You know you get quite a spectrum of people and, uh, you know, I mean the thing is is like you're always tempted to just do the arch and even if you do see some of these red flags, a lot of times you're like, you know, I still want to do the case, like I still can make a difference in this person's life. Maybe it'll be different. And you know, sometimes you kind of set yourself up for these things.

Speaker 2:

You know, sometimes you kind of set yourself up for these things, you know, I know, I do it, that happens so many times and this is another humbling reason why I start the courses that way is like guys, somebody lift a hand here who hasn't had a complicated patient, you know, and everybody's like, yeah, I have, you know. Like kind of like the first stone. If you haven't, you know. Yeah, it's like we've all had a patient that you wish you hadn't treated or at least and this is part of our teaching is you reprogram the patient?

Speaker 2:

And reprogramming means saying the right things Like hey, listen, this might be forever.

Speaker 1:

This could also not be forever?

Speaker 2:

How long does it last? This could work out perfectly. This could also come back. You get some failed implants some failed implants. Listen, we're gonna have to redo surgery, oh my god. So it's not like a one and done sometimes. Sometimes it's not, you know and all these things that you have to say when I talk about it in my course, like, make sure you tell the patient this before they get into this. You might be immediate load.

Speaker 1:

There's a possibility you walk out of here with dentures again Wait a minute, but don't you do Somebody?

Speaker 2:

goes and stuff like that. There's a possibility that you walk out of here with dentures, you in it or not, you know. Yeah, those little things Cause I had the patient about six years ago. Man, One time it happened, one time only. I told them hey, don't worry, I teach about this, I know different techniques. I said you walk out of here with fixed teeth. I said that man, I don't know how many people say that Like yeah, yeah, we're doing fixed, you know Fixed podcast. But we're doing fixed Well of course it's fixed.

Speaker 1:

You see the light up sign I got in my office.

Speaker 2:

Of course you're walking out with fixed teeth, the, the ways of the arches, I know all the ways, man, that's right. And little did I know. Like it was not a butter case you know even SIGOS, like I wasn't doing SIGOS back then, but like it was a butter all throughout case and I was like Just push it through, yeah. Then your patient wakes up. We had a problem. We had a little argument. Obviously I didn't you know. Case is fine now, but that's the last time I said. This is fixed.

Speaker 1:

I said yeah, you don't, you don't give a guarantee.

Speaker 2:

You want fixed. We both want fixed, you know, yeah, but we'll see. And my patients, nowadays I get a case if I do, which is super, super rare, but if I do that it's not fixed. It's like oh all right, dr Nestor, three months with this denture, you know sure we'll do it.

Speaker 1:

Yeah, I think that's a great way to put that too. And, like I, you know it's been a while since I haven't loaded a case. I think it's been maybe a year and a half or so, like, maybe something like that. But you know, I tell the patient I was like look, you know, I want you to have the peace of mind. Almost all of our cases walk out of here with fixed teeth. But there is that chance. It's a non-zero probability. But you know what? If things don't go well, then you're just going to go through the same process that everybody was 20 years ago and it should work out okay.

Speaker 1:

We just have a different approach for that. And 100% you have to open the door and let a patient walk through it. You can't just pull them through after the fact. Explaining, because it's, you know, explaining it after the fact is an excuse. You know. Explaining beforehand that that's consent, that's letting them know that that's there. So it's not a surprise and that's one of the best lessons you can learn in full arts is just don't set yourself up for having that really difficult conversation of hey, I know I said you were going to be good and you're not, and this is why you know. So yeah, no, that's a great bit there.