The Fixed Podcast

The Fixed Podcast Meets 3 on 6: Insights into FP1

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The waiting room tells the story before we do: patients are traveling, paying more, and asking for three‑on‑six because it feels like teeth—thin, cleanable, and quiet—without carving bone to hide bulk. We sat down with Dr. Randy Roberts and Dr. Logan Lock efor a candid look at FP1‑based full‑arch care, and why a prosthetic‑first plan can upend old assumptions about high smile lines, bone reduction, and “the lab will save it” thinking.

Across a week in their clinic, we watched uncherry‑picked live seats, learned how every extraction and implant becomes a fiducial, and saw why direct‑to‑fixture workflows with internal angle correction make or break access. The mantra is simple but demanding: set the incisal edge first, design ideal teeth, then place implants to serve the prosthetic. That’s how segmented bridges seat fast, phonetics settle quickly, and hygiene stays human. We also walked through high smile line protocols that often avoid macro reduction entirely—suturing tissue to the prosthetic and letting biology re‑establish space—sometimes with nothing more than a subtle 2 mm contour to adjust lip support and display.

For clinicians, this is less about picking a side—FP1 vs FP3—and more about expanding options and matching them to the right patient. Younger arches with good bone and tissue deserve a conversation that preserves structure; complex FP3 remains essential when indications call for it. We compare cost positioning, outline a sane training path that builds from solid FP3 into guided FP1 before extreme anchorage, and share the thousand tiny steps that keep a 30‑minute seat from turning into two hours. Most of all, we talk value: why educated patients don’t want the cheapest full‑arch, they want the thinnest, most natural, and most durable one they can maintain for years.

If this conversation sparks ideas—or challenges your habits—hit follow, share the episode with a colleague, and leave a review with your biggest FP1 question. Your feedback guides future deep dives and live case breakdowns.

SPEAKER_01:

My name is Dr. Tyler Tilbert, and I'm Dr.

SPEAKER_02:

Soren Poppy, and you're listening to the Fixed Podcast, your source for all things implant dentistry.

SPEAKER_01:

Hello, and welcome to a very special edition of the Fixed Podcast, one of our first crossovers with Dr.

SPEAKER_03:

Randy Roberts and the Three on Six Podcast with Dr. Logan Lock. Dr. Soren Poppy.

SPEAKER_04:

Dr. Caleb Stodd. Yeah, this guy.

SPEAKER_01:

Yeah, so this is Fixed on Six. And so here we are, you know, the regular Fixed Podcast guys, and we're we've come out to this course to learn what all the fuss is about when it comes to three-on-six. We've talked a little bit about FP1 modalities on our show before. We've always been a little bit wary of it, you know, more show a lot of concern for a lot of things that we've already talked about. You know, if you got a high smile line, you got uh you know implant failures being harder to take care of, um, higher patient expectations, perhaps, all kinds of things, gum recession. All these things uh you know have really kept us away from that type of modality for a long time. But we've been seeing this three-on-six stuff for so long. Of course, we've had um Dr. Locke and uh Dr. Roberts on the show before, and now we're really getting to see you know how the sausage is made, right? We've been in the clinic, we've been looking at their post ops, uh, looking at their deliveries, learning the whole surgical process. We'll actually be doing surgery tomorrow. Of course, we're gonna talk about that eventually. Um, and uh we're here to share a little bit about why all the folks, I mean, we have a very large audience of people that are doing tons of FT3, signs of implantology, why they might need to open their eyes a little bit to what's going on here. So I'd really appreciate it, guys, if you could give us a little bit of background about what 306 is for those that are uninitiated and what it's become at this point and what it means potentially for providers.

SPEAKER_03:

Okay. Well, I'll start. Um, I feel like uh the reason that you guys are interested and potentially um other doctors is really because the patients are driving this. It's something that as we've been doing it and getting good results, our patients are so excited and happy that they found this and that it's at a reasonable price. And they're like, How did I not know about this? I almost did the other thing, and there was no coming back from that. And when they got this and they found out that it was like having teeth in their mouth again, and and so they become so excited about them, like trying to tell the world, they're like, No, no, no, you have to do this. Like this, I didn't know, and I almost did that too. And so we've got these cheerleaders that are going around, and a lot of doctors like you guys are finding out about it and finding out the the extent of how much patients love this from the patients. And it's it's like I've been trying to tell people I think it's better for many years, and people are like, Dr. Roberts, we're pretty sure you're done. And you know, and maybe they're right, I don't know. But but my patients, they and Dr. Locke's patients and the doc and the three-on-six patients around the country that are getting it done from our providers, they're so excited and so happy about what they're getting.

SPEAKER_00:

We love when we get doctors that come to the course because patients are pushing them. And those are the best kind of doctors because they're looking out for the interests of their patients, they hear it in their offices, and we love to know that they're hearing it in their offices. And so to uh to get doctors that come out because patients are driving that is a huge testament to what 3 on 6 is and how much patients love it, just like Dr. Roberts said.

SPEAKER_02:

Yeah, I think it's uh it's very important for clinicians to have um just different options for patients, right? Um, you know, in our office we do a lot of FP3, that's kind of typically what we're doing. Um, and you know, a lot of the patients that are coming in to our offices for the treatment, they are at a place that maybe they've been in addenture for like 20 years, and and doing an FP3 is totally comfortable. But but those patients who uh maybe are a little bit younger in their 40s who um still have that good bone and they aren't in a situation where uh you know that we need to remove all of that bone, it's in a wonderful option to provide. Um and ultimately it's gonna come down to the patient's decision what their goal is if they're looking for for function or aesthetics or whatnot. Um, however, being able to offer you know that treatment to the patients and give them the option of, hey, you can have an FP3, maybe it's a little bit cheaper for you, or if you want this FP1-based prosthetic, it is gonna be thinner, maybe have uh less less um like sound when they're coming together, feel a little bit more natural, um, but it will be a little bit more expensive, and then give that patient the choice and let them decide.

SPEAKER_01:

Yeah, I definitely like that it's it's a higher order of service, right? And it it also helps set some expectations, even if someone does eventually go down the FP3 road, yeah, maybe due to finances, they understand that there was a road that they chose not to go down that may have given them that more natural feel. They may have not had some of the phonetic issues they deal with. Um, you know, maybe they it would have been a little bit less accommodation. So at least they're primed to understand that they didn't choose to go that way. And now that they're they're choosing a path where there will be some more accommodation, yeah. Maybe they are gonna have some bone removed, right? Like they they can kind of, you know, it's allowing them to choose that path and not just having them, you know, face those sorts of consequences later on. Um and uh, you know, I I definitely think that where a lot of of friction has come about in the conversation between FP3 versus FP1, FP1 versus 3 on 6, whatever, comes from this sort of ether or mentality, the one or the other is somehow just better for everybody. I don't necessarily think that's true. And now I will say that I have been very impressed and humbled by some of the cases that you guys have been able to fit in this three-on-six box because some of the ones I've seen I would never have predicted would have done that. Um, but you know, I I think that we have to see a world where these two things can coexist and there are appropriate situations for different patients. Um and there is also a financial reality of it as well. Like, three on six shouldn't be as cheap as all on X. It shouldn't, because it's definitely not the same thing. I mean, and frankly, it's just not um, I mean, all of us know this is there's just not nearly as much orchestration that has to go into doing an all-in-is case. Like if you are capable of laying a flap, finding bone, and just putting it in relatively the right spots with the right sort of timing and things like that, you can be very successful in the lab. We'll do a whole lot of work to make that case a slam dunk. With this, that it does not work that way. You don't just walk in without really knowing that case. Um, and you have to know every extraction, every tooth is going to be used as a fiducial, every implant, every implant size, where you're trying to come out, exactly what kind of correction you're getting, because your access holes are gonna have to be money for this to really make sense, you know.

SPEAKER_00:

Yeah, you don't give yourself enough credit as far as the FP3 side of things goes. Because we, you know, Randy and I see a lot of of cases come in, and I know and I've seen a lot of what you guys are putting out, and it's uh on the scale of FP3 side of things, I think it's the most stable, the some of the best stuff that's that's out there. I appreciate it. Um but it is a it's a different world, and it's a really rewarding field to be in. And you guys, as part of this training, we have um been seeing a lot of live patients, patients that came through our last training, and you've seen that there is it's fairly predictable. I mean, we had three final seats today, and all three of them, they're not cherry-picked by any stretch of the imagination, and they uh they look good. Patients are ecstatic with the results, and it's something that can be done predictably if kind of the recipe is followed.

SPEAKER_03:

And that's something that a lot of the doctors that have come through our course have said that they've never seen before, that they got to actually just see the patients that were on the schedule for that normal time to just get the normal work done, right? Normally doctors are only cherry-picking patients and being like, oh, come look at this patient up. Yeah, okay, here's the patient that's on our schedule. We're going to seat their teeth on, or we're gonna take their scans just because this is when they're scheduled for it. Right. Yeah. And so um you got to see three of those patients um that had beautiful teeth and beautiful tissue, and that have, you know, and the first two actually were from training. So those are from doctors that were just learning, learning how to do it last time with the with a beautiful result.

SPEAKER_02:

I think it's important too because um we got to see, you know, how you guys manage certain uh complications, not necessarily complications, right? But like um, you know, if a bridge isn't seating exactly properly, like what are the processes that you guys are taking to make sure that seats? And every dentist, no matter what treatment you're doing, but especially these full mouth cases, you're gonna run into those little things. And those little things are what can make a you know, like a seating appointment that's supposed to take 30 minutes turn into like an hour and a half, two hours. Yeah. Um, but if you cat catch these little like gold nugget tips and see how you guys are seating these segmented bridges, um it does go a really long way for the doctors to ensure that they're feeling comfortable when they're doing, you know, not only their surgery appointment, but also that post-op care.

SPEAKER_01:

Yeah. Yeah, and I think one thing too is uh, you know, especially talking about the the deliveries and like how you maneuver these types of things, not only is it different because you're working with a segmented bridge, but something we've also been able to see here, which is somewhat fairly new in our spaces, maybe not new, but it's new again, is the direct-to-fixture aspect of it, like taking out the multi-unit. That's something that I I mean I had no clue. You know, I mean, I I kind of went straight into all in X and and using multi-unit and restoring at a multi-unit level. And I do some single unit stuff, some bridges here and there, but it's never really been my huge forte. And now this whole case is is it's F V1 direct-to-fixture. How do you navigate a full mouth of that? And for me, that was very, very intimidating. I'm seeing how you're able to make it more predictable. Um, but I'm also seeing why, you know, a system like TRI potentially makes this a whole lot simpler, right? Especially when it comes to the timing aspect of things. That's another thing I was very concerned about, is like in how you make these cases work. And doing that direct-to-fixture that has its own internal angle correction seems to have made that a little simpler for you guys. Um, so that that's I think that's where a lot of us have been humbled and trying to work through that and and learn what that might look like. Um, if maybe that is the best way to do this type of cancer. Yeah, yeah.

SPEAKER_00:

Yeah. Yeah, we and that's something we work heavily on, and we see so many of these patients, and Randy does a great job at putting in the time and researching different ways to make the process simpler and to make the results better and to get thicker tissue around the implants. And he's doing this stuff while I'm trying to figure out okay, how do I simplify it so we can train the doctors? And then once I start seeing his pictures, really it's me going in and be like, oh, this looks really good. Like this is starting to, this is looking better than my cases. It's time to implement this new thing into what I'm doing and to what we're pushing out to all of our doctors. And I think that's one of the great things about 3 on 6 is it is a constant work in progress, and we are just trying to push the limits on what we can do as far as FP1 goes. And um, we're constantly trying to make it simpler for our doctors and more predictable for our patients and on our fan clubs that are out there that they're getting the same result, you know, in Boise that they're gonna get here in Salt Lake, so they can stay at home.

SPEAKER_04:

I yeah, one yeah, one thing I noticed like my biggest takeaway from being here with you guys is you you're not afraid of innovation, right? That's what you're talking about. Where we we came and you have multiple different implant brands, you have like every single type of photogrammetry unit, you have different scanners, you have all the different lasers. Like, really, if you wanted to tour or to go through a museum of all the different things that have been involved, like like in dentistry, then you could walk back here. I swear that you probably have like a pedal drill somewhere back here. So, um, and I think it takes a lot of humility to do that to a lot of our mentors, right? Um, as we go through and kind of learn this, and there's been evolutions of this throughout time, they're really stuck in their way. And maybe it's not for the worst, but sometimes it's not for the best. And you get a lot of, you know, nobody's really accepted when you're the only one talking about something. And and I bet Randy's had to deal with a lot of that throughout her career. Um, but with time and with experience, you're you're proving what's possible and you're pushing limits. And these limits are better for patients in a lot of ways. I know there's a lot of patients that I've had that have received really good treatments given the information that I had at the time. Um, but there's also some that could have benefited from three-on-six so much more than just, you know, doing six implants and having pterygoids and stuff like that. So that that's been my biggest takeaway is humility, innovation, never afraid to reassess what you're doing. And it's not about you. Like with a lot of a lot of instructors out there, it's actually more about the ego than it is about the process or the patient. And with you guys, I can definitely feel that it's it's not about you, it's more about your patients 100%. I loved seeing that.

SPEAKER_03:

Yeah, and we love bringing on doctors like you guys because we always feel like we can do better and we can be better. And when we bring on awesome doctors, like you guys are always also being like, like our conversation earlier, like with taxes and stuff like that. And you're like, we can help you out in these different ways. And it's like, and also there's different ways, and also with the surgeries and different things where our doctors help us out, and we all kind of grow together. I feel like this is a a big family, and like you said, we're we're trying not to have egos and we're just trying to all work together and figure out how we can make the best products that we can for our patients.

SPEAKER_02:

Yeah, and ultimately that's what it comes down to is just um creating the skill so that we can treat our patients with the the best possible care, you know. And when they come to our offices, like I see patients all the time that um, and we talked about this a little bit earlier, Randy, but they go to like the cheapest provider on the block just because of the cost, and they just don't understand that. And it's it's difficult to we try to put out content on our YouTube and whatever to portray to our patients like, hey, everything is not all the same. It's not just like you're gonna get implants placed this the exact same way every single place. Maybe it feels like that for the first year or two, but once those implants start um, you know, degrading a little bit, you're in a situation where that treatment cost that you saved is gonna end up costing you a heck of a lot more when you go and have to have it redone. Um so it's important for patients too to uh to listen to stuff like this, right? Um, or for us to to give that uh education to our patients so they understand that, hey, maybe don't fly to to Mexico or fly, you know, to to wherever it is to get this treatment done, not because there isn't great doctors there, but because it's harder to determine what is a good provider and what isn't in these other countries. Um and ultimately I know plenty of great providers in these other areas. However, if you go to somebody who's been to like three on six, been to Orca, been to a lot of these courses, you'll know that you get you're going to a solid clinician that has spent the time on the weekends where they could be doing other stuff to excel and be a better clinician.

SPEAKER_01:

Well, I think something that you guys have done that's so impressive is when we first started Smile Now, we identified that, you know, across the market of all in X providers, there's a race to the bottom happening. And I think there's a lot of assumptions being made about these patients that really aren't fair. And it's that, you know, they're they're bargain vendors, right? They just they price shop, they're looking for the cheapest number, they'll go to the sm the lowest number that they can see. And that's why we're seeing some of these cases that are being done for eight, ten thousand dollars an arch or something, and people are going way out of the way to just get the cheapest possible thing. And we try so hard on our content side to really build value and make people understand that it's you know, you you don't buy a chicken sandwich at Wendy's and Chick-fil-A and expect the same product, right? And uh what you guys have done has shown that this patient base, there is a very significant contingent that is willing to spend more money for value. Yeah, if it's something different and they know it's something unique, they will go for that. And they are coming from literally all over the world to come get this done. And you guys have really shown the value of what you're doing. Like, and and these are very well educated patients, they've done their research, they're not valuable, like they they have really gone through Reddit, through Facebook, they've learned so much about anthology, right? Um sometimes. Sometimes, sometimes they have to ask the question. I'm like, hmm, I might need to check this in the other room. And and they do appreciate value. And so I think that it really brings a charge to full arts providers around the country to ask themselves how can I convey value and value what it is that I do and not just feel like I just have to keep doing this for less and less money over time, because that, of course, is a self-limiting belief. Like that cannot, you know, persevere through our time. And so, you know, it really sold me that not only is it a value for provider to come here and learn how to do this kind of thing, but patients will see that and they will value. And it's it's it's much easier to do that when there's something like that, right? When there's something like three on six that can then vet and validate you as a doctor that can provide it. And two, what I what I'd been surprised on, and and I think that a limiting belief that a lot of people that see three-on-six will have is that some of this is cherry-picked. Anybody can take a photo of their best case and put it on Facebook and say, hey, look what I did, right? But that is not what's happening here. I mean, you guys have done over a thousand of these. We've seen these patients coming in and out. They're not cherry-picked. We've seen things that maybe weren't totally perfect and they need to be worked on, but like you're getting to this result and these photos very particularly. I mean, I saw your phone, right?

SPEAKER_00:

Yeah, we I we pop up the phone on the screen and it's I think your case goes the last week.

SPEAKER_01:

It's very consistent. And it's, you know, I I think Danny Domain said this in one of his talks over ICY or something like that. It's like, don't show me your best case, show me your last one. And I know both of you can show us your last case, and it's going to match that same quality, the same stuff you post on Facebook. So there is a system to do this for patients, and there are patients that do value this. So that calculus should show you as a provider that there is something here that you should at least give some time.

unknown:

Yeah.

SPEAKER_03:

Well, thank you. Yeah, it's uh definitely been a journey to get to where we're at right now, where we're getting these predictable results, and so many different techniques, like the uh like the one that I don't know, I feel like I've gotten so much crap over all these different things. I I'll go on different Facebook groups and I'll say, hey, um, healing tissue by secondary intention is really helping me to grow a lot of tissue. And everybody's like, what are you talking about? I'm like, I'm just saying what I noticed when I'm doing it this way. Yeah. Right. And like it's all these people give me so much crap. I'm like, yeah, I won't share what I'm learning with you guys if you're all gonna be pissed at me for sharing. Right. But I feel like I've gotten so much of that. It's been a journey, is what I'm saying. Yeah. To get to this point where we're getting predictable, beautiful results, and it's required. Like, I don't know, you've seen there's probably like a thousand things that Logan taught you over the week. So many little tiny things that all add up to uh one thing, right? But if you miss any of those little tiny things, then the final result is off a little bit. And like each one of those things makes a little bit of a difference. So it's just uh it's it's awesome to be where we're at right now, but it's been a long and hard journey to get here for sure.

SPEAKER_02:

And I'll say too, we, you know, something that we've been very uh cautious of is when we place our implants, we want to make sure our patients are getting the thinnest prosthetic possible with our FP3 cases. That's always been a huge philosophy of ours. You know, when you have a patient that's class two, like angling the upper implants back and the lower ones forward to kind of correct that and make sure that that FP3 they're getting is incredibly thin. Um, but we've taken a lot of time to learn how to angle our implants properly and do those things in our offices. And something that I see a lot in coming here, we also got a lot of tips for how you guys do that to make your prosthetics as well. But I think something that a lot of doctors need to improve on is to think about their implant placements prosthetically, not just where maybe there's the most amount of bone, but what's the most comfort for patients while also considering the amount of bone. Um, and coming to a course like this is gonna kind of open their eyes to the abilities of, you know, we don't want to be looting a denture in this patient's mouth. They're not paying$40,000,$50,000,$60,000 to just have this big hunk of zirconia, you know, stabilizing the mouth. They're paying for that to have a functional set of teeth, a body part that's as close to what they had previously as we can provide. So uh that's something that I think is really, really important that I want more clinicians to really consider when they're treating these patients. Um, because ultimately, any clinician that's doing this procedure, you know, it's it is kind of the visual of all on four, all on six, three on six for the whole um culture. And we want to make sure that every provider that's doing these does them well. Um, and taking time to, you know, come to courses like this so we can so providers can learn how to improve and make their prosthetics thinner for the patients is gonna go a really long way, not only for that clinician's abilities, but also the industry as a whole, um, to ensure that patients understand that the difference between a denture and a prosthetic is incredibly valuable, right? And the difference between uh a set of teeth and that truck they were gonna buy, right, it's more important to get that set of teeth.

SPEAKER_03:

Um I also feel like it's really important that all of the doctors who are placing FP3 also can do FP1 so that they can give that or at least tell their patients that that that that's an option. Yeah. Because I feel like if they don't know how to do FP1, they're not going to give it as an option. Their only option will be FP3, which means even if they have a 29-year-old with perfect bone and tissue, they say, well, your teeth need to go. The option are dentures or FP3, and we're gonna have to chop away your bone. And so without even being able to tell them, there is an option where we can give you a full moth of implants and save your bone and your tissue. I feel like that needs to happen. I feel like that needs to be part of the conversation. And so I I think that if that patient finds out that this was something that exists the day after surgery and they're like, hold on a second, I could have had that when this happened, then I think that doctor potentially is could be in trouble with that patient. And so I just feel like it's important for doctors to be able to at least give that as an option or let at least let them know that that's uh available in the market if it's not something that they're able to do.

SPEAKER_04:

Where would, yeah, following up on that, like where would you rank the way that you guys teach about how to do FP1? Where would you rank that if there was a hierarchy of difficulty of different types of implants, right? So we have we have just traditional, um, and then you have like pterygoid, you have zygomatic, you you have FP3. Where would you rank what you do in comparison to those?

SPEAKER_00:

It's funny watching it because I I've had the um blessing to watch some really talented surgeons do some insane, some really beautiful FP3 and quad zygos and you guys with pterygoids, like there's some finesse to all of it. And so I don't know that one is necessarily um you know, watching that that is a difficult thing, and you have to deal with difficult complications. And but I do feel like FP1 has a certain finesse to it. Um and artistry and it requires and and a lot of planning and a little bit more background in all of the things to be able to accomplish it perfectly. You know, we talk about um atriumatic extractions and being able to get the teeth out without breaking bone and starting there. So we have to start teaching at the you know, something that most doctors are very familiar with, but maybe not as careful as we have to be in order to get the best results possible. And then we go through you know the planning and the guides and how to seed a guide and spending the time to do that. And so there is a there is a finesse to it, and then tissue management, which is a little bit more important than FE3 in most cases. So um I would put it up there, but I think uh you know, watching you guys do your work as well, there's that's complicated too, and you have to go through a lot of training to be able to do those remote anchorage to do the kind of stuff you're doing as well.

SPEAKER_02:

I will say that um in my opinion, and kind of going off of your question, is that you know doctors definitely can provide FP1. Like if they have good fixed, like all on four based treatment, I think FP1 is a great next step. Um I would prefer to have the ability to do FP1 guided in my office before jumping into like zygomatic and like these crazy remote anchorage-based techniques because you know, a lot of the reason that doctors go to do those remote anchorage techniques is to open their office up to more potential patients, right? But those more potential patients that you're opening your office up to come with a lot of headache, a lot of complications that that provider might not be fully prepared to um handle. Whereas going from, you know, just traditional all-in-for FP3 to like guided FP1, that's a pretty easy jump. Um, and it's gonna mean a lot more care about tissue and focusing on these things, which then is a good um accelerant to doing like zygo and some of these other cases where you might not think about it, right? It feels more macro level, but ultimately you're gonna have oral anterior communications, you're gonna have issues with tissue that you need to solve. Um, so I feel like it that would kind of be what I would recommend is, you know, like we always say, get really good at basic surgery over or regular dentures, then snap-ins, then your most basic all on four, and maybe like a little bit more challenging all-in-for, so you can solve some of those implant failures, palatal approach, pterygoids, but then jumping into FP1 is where I would personally jump to prior to getting into like transcinus and zygomatic and some of these crazy surgical techniques.

SPEAKER_00:

Yeah, I think often it's the the biggest one of the biggest concerns we hear a lot is the complications of FP1 because we're dealing in an aesthetic zone and there's not a lot that you can hide. Um but overall the complications for us are fairly minimal.

SPEAKER_02:

If you do them, like you said, with all the little tips.

SPEAKER_00:

Yeah, if you do them the right way and you're preparing yourself for the future, then you know some of our biggest complications are an implant fails, we take it out and we do a new prosthetic over five implants instead of six. Or we take it out and we shift it and we make a new prosthetic.

SPEAKER_03:

Um or the teeth are slightly longer, you know, and that's I think that's one of the things that most doctors are afraid of. They're like, what if I do it and the teeth are a little bit longer? And in my experience, I've had a ton of patients whose teeth are slightly longer in some areas than others, and and even some of the ones that I post to people, and I'm like, um, they'll say those look beautiful, and probably won't notice that that canine is a millimeter or two longer than the other canine because it has a little bit more tissue or whatever. And it's not necessarily a huge complication because most people's natural dentition looks like that. They don't have perfectly exact same tissue heights on every single tooth. And so if it's slightly off, not that big of a deal because you still have all of the advantages of your teeth being so much thinner, so much easier to clean. Um, so for me personally, I think that even if like I think that the doctors should be learning this before doing the FP3s, just because I think that worst case scenario, they just have longer teeth that are still narrow that feel more comfortable. Like it just might not look as natural for the doctors doing it their first time. Like maybe they'll break off more of that buckle bone, and maybe the gums aren't going to look as perfect. In my experience, the patients don't super care most of the time that their gums look perfect, they care that their smile looks really good, and your gums don't most of the time really show all that much. So making sure, and that's one of the things that the lab is taking care of for you, making sure that the smile looks really good. Um, and making sure that the gums look perfect, that's more on the doctor, and the newer doctors are probably gonna have less perfect gums than the doctors that have more experience. Yeah, but even still, I think that that's something that they'll have to learn, start learning at some point. And having that restoration be so much narrower has so many advantages that I I'd rather have them be starting there than starting with the FP3.

SPEAKER_01:

You know, something that I think is uh, you know, kind of uh the trend, right, is as a person goes through their progression as a surgeon, is especially in the FP3 world, it's always like you're getting more advanced as you take cases on that have less bone available, right? It's always how do I make FP3 work when there's less and less? So, you know, what if we don't have zone two bone, right? What if we don't have a whole lot of zone one bone? What if, what if uh this area is super thin, you know, whatever. Let's go to a terrible, let's go to a zygote, let's deal with less and less and less. And you know what? That is a growing problem because we keep approaching all these cases with an FP3 mentality and we keep hacking a lot of bone away, right? Well, what if, though, the more advanced thing to learn is what you do when there's more bone? Because maybe the answer isn't just to get rid of that, right? So, like one of the main things when I was first learning about FP1 versus FP3, which is you know, FV1 is usually just kind of a it gets glossed over, leave it to the prostodontist, don't worry about it, right? Is what if the other patient has a high smile line? And that used to be an indication in my mind you shouldn't do FP1 because you don't want the gums to be visible, right? We're supposed to hide our work, right? But one thing I've been sold on with you guys is that no, you don't, that does not mean you need to do FP3. In fact, that's one of the worst things you can do because now you're gonna be removing even more. You're gonna remove 15, 20 millimeters to try and make this case work and try and fit into the FP3 world. And so we've seen tons of cases, some of them live today, like in the chair, that had high smile lines. And either you preserve that, and this is entirely based off of patient accritations or what they wanted, um, or you reduced it and actually left some gung on purpose and made it absolutely beautiful and harmonious without even actually removing that much bone. So can you guys talk a little bit about how 3 on 6 approaches those high smile line cases, how you're able to plan for that, what's the approach like, how much bone does get removed, how does the prosthetic make that work?

SPEAKER_00:

Yeah, so the way we the way we generally train it, a lot of it depends on how um how much of a gummy smile they have, how high that smile line is, where the teeth, where we want the teeth to end up. But um a lot of doctors come to us and they ask for like. Like a bone reduction guide, something to help them create that architecture. And I often have to steer them away from doing something as macro, we talk about micro and macro, doing something as macro as that. Because really, what we try and do is we use our prosthetics. Our lab is trained to create pontic sites, to create natural-looking aesthetics. We want to use the prosthetic to guide the development of the bone and the tissue. So oftentimes in the cases that we did, we are removing very, very little bone or none at all. Maybe we're just putting the prosthetic right at the bone level. And what that does over time, um, as we suture the tissue to the prosthetic, it's going to allow resorption on its own, and we get rid of a gummy smile without taking a bird in. It's a guided bone degeneration.

SPEAKER_03:

So really we're guided bone loss. Yeah, that's right. So really we're shooting for the incisal edge where we want that to be. Yeah. And then we're going up from there for what the ideal teeth shape and length are. And so we're going to say, okay, this is where I want the incisal edge, and then the lab will plan the rest of it up from there. So, and we're using our instaresa scan so that we can know exactly where their smile is with their picture, where it is in their bones, so that we can map that all out before we start. Um, so then we have our ideal teeth, what their ideal shape and size, and that's going to be adjusted depending on the size and shape of the patient's mouth and their lips. And so normally we're going over that with our patient or with our lab uh before we'll even start placing the implants in the surgical guide. So we start with the prosthetic, we start with where the incisal ledge is, and then we will start with that design. Once we know exactly where the teeth are gonna go, then we're gonna start designing the implants and so that we can start knowing exactly what angulation those implants need to be in so that they can uh so that the screws can be coming out at just the right spot.

SPEAKER_01:

And what depth and what depth the implants are to then guide that, to then raise that smile line, raise that.

SPEAKER_04:

I did I had a periodonist in the military that taught me um that you can either do clinical crown lengthening with a burr or you can do it by invading the biological width. Yeah. Right. And that's what you're talking about. That's essentially. So you just you just invade that, you put pressure on the bone, the the body's gonna respond accurately, it's gonna re-establish the biological width with the like attempting to get that three millimeters of gingival tissue.

SPEAKER_00:

So Yeah, and we had two of those cases today, your case and and one of ours from our training patients uh three months ago. And say we didn't we didn't I don't know if you took a bird of years, but during the training, we didn't we didn't touch the bone at all. And you saw the reduction in how much gum she was showing when she smiled. It's purely based on the prosthetic alone.

SPEAKER_03:

On mine, she had about like six millimeters of gum showing when she was smiling beforehand, and I removed about two millimeters, and on her her bone was coming out pretty far at a like an angle facially, so taking off two millimeters brought it out, uh brought it back and brought it down. So but anyways, it made a much more aesthetic.

SPEAKER_04:

I think that case too, because that was kind of one of those aha moments for me, is is looking at the results that you were able to obtain on that case because she had excessive lip support, right? And you reduced that two millimeters from a buccal lingual or buccal palatal uh dimension. And then it I think it also allowed her lip to relax a little bit more and it gained a little bit of length by doing that. So she had a little bit less yeah, yeah, gingival show. And it that was so beautiful. She looked amazing. Um her before and after is probably one of the most the the most beautiful ones that you could see.

SPEAKER_01:

So thank you.