The Fixed Podcast

Learning from the Giants: Dr. Jerik's Insights on Subperiosteal Implants: Part 1

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What if the “new” thing in full-arch isn’t actually new—and the real breakthrough is remembering what already worked? We sit down with Dr. Samuel Jirk to unpack eight decades of subperiosteal design and how those lessons should guide today’s patient‑specific implants. From the first time he watched a 14‑unit FP1 delivered over 10 implants at daybreak, to building an in‑house digital lab, his path reveals how mentorship, biomechanics, and occlusion still decide who gets predictable outcomes.

We walk through the foundations laid by the Misch Institute—prosthetics before surgery, divisions of available bone, and RP1–FP4 categories—and why that structure keeps full‑arch treatment safe as complexity rises. Then we challenge the hype around PSIs: CT‑based subs have a long history, and success has always hinged on load direction and soft tissue tolerance. You’ll hear why remote anchorage to the lateral ramus and symphysis reduces crestal stress, how lattice “snowshoe” concepts translate to modern titanium, and why molar‑emerging posts invite dehiscence in thin tissue and active muscle zones. The goal isn’t thicker frameworks; it’s smarter ones—debulked, contoured, and placed where biology says yes.

Along the way, we talk real‑world fabrication—segmenting DICOMs, designing in Exocad and Blender, printing and milling, and even casting cobalt‑chrome when indicated. We also spotlight the underreported side of PSI literature, where two‑year complication rates near 26% demand humility and better design, not complacency. If you’re a surgeon or restorative dentist navigating AOX cases, zygos, or subperiosteals, this is a roadmap to pairing digital precision with time‑tested biomechanics and occlusion.

If this conversation sharpened your thinking, follow the show, share it with a colleague, and leave a review with your biggest takeaway. Your feedback helps more clinicians find practical, proven full‑arch insights.

SPEAKER_01:

My name is Dr. Tyler Tolbert, and I'm Dr. Storin Poppy, and you're listening to the Fix Podcast. Your stores are for all things in plant dentistry. All right, and welcome back to the Fixed Podcast. We have another very esteemed guest on with us today. Um took us quite a while to wrangle him because he's a very busy guy. You're gonna hear a lot about his resume and his current practice, which is still very, very busy. Um we have with us Dr. Samuel Jirak. Um he brings a wealth of information and knowledge and experience in full arch implontology. He's been doing this uh, frankly, longer than either uh Soren or I have been alive. So we're extremely humbled to have him on here. And, you know, one of the things that I originally reached out to him about, um, I saw that uh I believe at the upcoming Orca seminar, he's gonna be uh lecturing on uh customized uh subperiospules. And uh, you know, I know that he had extensive, extensive experience with that, not just the ones that we're talking about today, but also the ones of yesteryear, how that's been done in the past, what we can learn from that, the good, the bad, the ugly, and what the next path forward um for customized implants looks like. And there's really not anyone else I could think of that would bring a more comprehensive experience to speak to that topic um than Dr. Jarick himself. Uh also, he's got a wealth of information about all things full arch. He does it all, um, everything that we talk about. So we're super, super excited to have him on and uh very grateful uh for him to spare his time with us. So thanks so much for coming on, Dr. Jarick.

SPEAKER_02:

Thank you very much, Tyler. It's just a privilege to be part of it.

SPEAKER_01:

For sure. So uh for those who don't know who you are, um, we'd appreciate if you could just kind of give us a little bit of background about you know your journey through Full Arch as a dentist, you know, getting into implants, how things have kind of evolved since then, and and kind of bring us all the way up to you know the current day.

SPEAKER_02:

Okay. Well, uh first of all, 1986 graduate University of Tennessee uh health center uh dental school. And um, you know, when we were in dental school, you know, dental implants were not taught. Uh we had literally one lecture on it and had a great oral surgery department. Uh we did a lot of work in the oral surgery department in undergrad. But basically, the lecture was here I am the oral surgeon, here's this dental implant done by some cowboy over in East Arkansas, and here I am taking it out because it's failing and they're horrible, they don't work. And all I could think at the time was, wow, if these things work, wouldn't this be great? You know, better than a denture or a partial. So um, you know, run out of dental school, I mean, uh, I'm a CE junkie, and it started from day one. Believe it or not, my very first course, my very first CE was an implant course, and there were five manufacturers at it. Uh Stereos, which later uh became Nobel or was bought out by Nobel, uh, you know, was there. Uh DB Driscoll was there, a couple others. There were plateform implants there. Of course, nobody's marketing subs because it was all root form, but uh, and I think Corvent was there, you know, and uh took that course and then you know kind of wandered around for about a year, and I had an orthodontist in the clinic that was from a small town in East Arkansas, and he kept telling me you need to go uh talk to my buddy up over there, Dr. Liljohn, uh, where I practice part-time, and he's he does more implants than anybody. And I'm like, you know, he's in the middle of farming country, Arkansas. There's no way this guy's doing implants in Arkansas, you know? Yeah, so uh this goes on for about a year, and I call him up, he's and I said, Hey, yeah, I heard you do implants. Yeah, he says, and I said, Do you mind if I come over and you know watch you do some implants one day? Come on, and of course, you know, he was working Fridays and um he starts at seven, and uh I drive an hour and a half over to his office and pull up in the back, and you know, there's a couple of Mercedes, a couple of Lincoln Town cars, a couple of real nice pickup trucks, and I walk in the back door, and the operatory, the main OR, was right at the back door, and I walk in, he's already working at 7 a.m. And he's delivering a 14 unit, which we call FP1, cemented, up to 10 implants with bilateral sinus grafts, and I think he'd done some uh tick soft tissue augmentation. Wow. And I my mouth just fell open, I'd never seen anything like it, you know. So uh I ended up leaving his office at seven that day, went to his house, wife cooked us dinner, he said, let's go up to the attic. And this guy had tens of thousands of slides, and he lectured you know nationally and internationally, even back in the 87. And I uh went up there and he says, Okay, Bubby, he says, you know, he says, obviously smart kid and everything, talented. And he says, but you don't know what you don't know. You don't know what you don't know. So at that point, you know, he went through a bunch of stuff and I said, Hey, do you mind if I come back? And he goes, Anytime. So I started taking off Fridays. I worked four days, you know, Monday through Thursday, and then every Friday I scrubbed in with Dr. Liljohn and assisted him. And we did sinus augmentations, we did subs, we did plateforms. Uh I think he didn't do ramus frames, he didn't believe in them. Uh, but he had been in practice 20 years, he started out life as an engineer. He was very active in AAID, he was one of the original uh ABY diplomates. He was in the first class that they accepted, one of the first examiners, uh, honored fellow. And so, you know, it was very blessed to have him in my life at that time. Um so he said, Well, we got to get you in some continued education. First place I went was Alabama Implant Study Group, and at the time they were doing a Congress which was attended by 120 to 1,500 doctors internationally once a year. Uh, Root Lab was a big sponsor, they had a big crawfish bowl, and they were showing their implant restorations and the subperiosteols and everything there. Um, you know, and they taught five courses a year, and it would be different instructors teaching everything from blades to root form to sinus augmentation. I mean, Bill Tatum was teaching sinus aughts there. I learned sinus augmentation from the man himself. Uh, and then you know, they were teaching subparaoscopes. So uh we would have a live surgery, it was done at Caraway Medical Hospital. We'd have a live surgery, uh closed circuit TV on uh that and uh attended all those and kept going back, ended up off started doing some surgeries for them uh and taking some patients to Birmingham to do that. And uh I got into AID, uh, you know, and that they really weren't pushing the associate fellow fellow stuff at that point in time yet. Uh started going to those meetings and southern district meetings, and uh you know, just had a lot of information come from a lot of different areas. Of course, you know, this is all before the internet. Uh you can't get on uh uh YouTube or TikTok and see how to do a pterygoid or any of this stuff like you can today. So, you know, you had to travel, and uh, you know, I'd just gotten married. My wife was a pharmaceutical rep. We waited a while to have kids, so we were double income, no kids. I traveled the country and I was doing 100, 200 hours a year continuing education, all implantology related. But uh the big turning point was you know, Carl Misch, uh Mish Institute had just gotten started. At the time it was still in Deerporn, Carl was teaching it. His one of his wives, Lori, was teaching the office management side. So you would literally take your staff to the first one, office managers, assistants, everybody. Uh hell, I think the hygienist even went. And um, it was all didactic, and Lori would teach the office management side. Carl was all didactic, and then we went back five times over the course of a year and a half taking our own patient. And we started out with the root form, then we did a plate form, then we did a sinusog, then we put the implants in the sinusog, and we actually did a subperioster. Carl was was teaching that and he was making some modifications, and we we did one of his modified. But Carl's courses compared to the courses today, you literally had two hours to do whatever you were doing. You had a mentor, I mean, Jack Hahn was one of my mentors, Craig, his brother, was one of my mentors. And just you think of an all-star, I mean, it's just unbelievable the opportunity at the time. But uh, you if you didn't get done in two hours, they pulled you out, you went to the class, and Carl was lecturing. And we're learning the divisions of available bone, we're learning, you know, RP1 to FP4, you know, it's just crazy. I mean, learning all the prosthetic, all the bone categories, and he brought everything together. And you know, I'm I'm pretty dis I'm very dyslexic. And so just being able to visualize and see, uh, it just made where any patient came in, uh, they fit a category, and you it was like, you know, his he was the first one. I think he coined the thing that implant dentistry is a prosthetic discipline with a surgical component. And so you never put implants in unless you plan the prosthetics. So, you know, that was just huge in in my learning. But, you know, I was able to, of course, do Hilt Tatum Sinus course. There were other courses I did back then, queries, bone technique. Uh, Craig Mish had a uh uh monoblock grafting course, you know, all sorts of courses back in the time, but Mish was the big turning point. Uh Hilt was trying to make uh implantology a specialty even back then. Uh at by that time I had received my fellow with AID uh in 1998, I believe it was, and then '99 I sat for my boards and passed those and became a diplomate. And at that time, Hill was like, look, I got a program starting up at Moma Linda. We're doing a residency program, you'll get a master's in implantology, and we're we're gonna take this and we're gonna make this a new specialty in dentistry. So I started uh doing that. Uh and you know, it was out in California, Seventh-day Adventist. So, you know, we couldn't do anything on Saturday. We started on Sunday, it went all week, and it was once a month, and I loved it. You know, the people that were there, the great doctors in the course, Jaime Lazada, his director now, he was in the first class. I was literally in the first class with these guys, and I did it for six months. We'd do the California one month, we'd go back to Mish Institute, do that for one month. Uh, and I did it for six months, and then my son was born, and I've like I've kind of reviewed because Mish was so comprehensive, so I bailed out, and that's the only thing I regret uh is bailing out. It would have been fun to have that master's, you know. Uh, but you know, as a general dentist in learning from Mish Institute, I was there with peridontists, prostodontists, oral surgeons, and a few handful of general GPs. You know, this wasn't taught in dental school, it wasn't taught in any residency program. So, you know, to get education in implantology, you know, we were learning from these practitioners like Kilt and Lil John and Harris and Kareem and Mark Davis and Mozanne, you know, that have been doing it for 10, 20 years already. And uh, you know, there was a lot of uh turf wars so far as well, only rural surgeons should do this. Nobel would only sell their implants to rural surgeons because only they could get certified in using a Nobel implant. But the fun thing was, I was in Mish early enough that I actually got certified Nobel, never placed their implant at the time because it was a little insulting that they wouldn't let a GP place it only rural surgeons. But uh, you know, it was a long, drawn-out process. And you know, I see so many young surgeons that come out of school now one or two years in, and they're like, they're wanting to do zygos. And I'm like, guys, take your time, get your reps in, uh, take and do this the right way. And uh, you know, back then it took a really, really long time to do this. But you know, I was blessed to have some really good mentors, you know, Dr. Lil'John, Dr. Mish, Tatum, Boyd Harris out of Fayetteville, Arkansas, Bill Careen out of Marion, uh, you know, Dan Root and Rob White and Rick Baynard for Moot Live were extremely instrumental in my training. You know, uh, I'd get myself in all sorts of trouble and they'd get me out of it every time, you know. And Rob, especially, you know, uh I didn't like using Root because they were so damn expensive and it took too long, and I could get it done for half the time the price twice as quick, you know, from a local lab, but every time I'd get it, you know, there'd be issues with it. And uh, you know, what I found out was you get what you pay for, you know, take your time, dial things in, and uh, you know, so they were very instrumental in my journey as well. Um, you know, other things that I've done since then, you know, early on, uh there was about 5% of the cases where the occlusion would just be a train wreck. And I realized I spent all this time in surgery, and I've spent zero time in surgery. So I jumped in uh Frank Spear when he was really big uh in the early 2000s, and he was doing hotel courses, and that'd be a thousand people attending, you know, down at the Swan in Orlando, and I did all those courses, and then if you had attended all those, he'd invite you uh for fee, of course, to show up at his office, and there was like 10 of us in there, and you'd spend four or five days with him one-on-one doing cases, dialing this in, and you know, Frank would, it was mainly cosmetic aesthetic dentistry, was a light touch of implantology, but the big thing was you know how to uh you know build these occlusions and these occlusal schemes and how to dial in that five percentage that you're having problems with. So, you know, once I had Spear in, you know, it's it was really uh instrumental in getting a lot of the issues that we had with occlusion and bites and you know things of that nature uh down the line. So yeah, it was a long process. I along the way you meet great guys like uh you know, Dr. Rakkowski, who you've had on. David Leggett and I went to dental school together. I literally didn't see him for 39 years, and he was at one of the last orcas that I was uh teaching at. And we got uh it was just like you know, we'd seen each other yesterday. That's cool. And uh it's it's a great opportunity. I was very active in AAID, uh, you know, in my 40s, uh, was a um president of the Southern District. I was getting ready to go do the national deal and and you know, go up the ladder there. And my kids had were you know young teenagers, and I decided to step back, spend more time with my family, wait, and I told them, I said, look, I'll come back when the kids go to school, you know, to college. And uh I did, don't regret it all. One of the best decisions I've ever made in my life for my family. Uh but the funny thing was, you know, in that eight, nine, ten years, uh things had moved on, you know. Uh they didn't need me, and I found out that there were other things to do, you know. I was still very active, but politically I wasn't, you know. Uh, but you know, AID was was very instrumental because you know, I felt very um dedicated to the diplomat and the fellow uh credentials that's being bona fide. I was very active in uh running that stuff through the legal system, supporting Frank Rekker and his efforts to make sure that our credentials were recognized in many states. And we were very successful when I was on the Board of Trustees. Uh, you know, I really worked hard to market the AID as the premier uh contact point for patients to find doctors who had qualifications and who had been tested. Uh and you know that's something that I felt like was very, very important, you know. And then of course, you know, as a board examiner for both AAID and and for ABY and still do that on from time to time. Uh, but you know, it's a it was a wonderful, wonderful career, you know, so far as being able to to be there and and see all these guys uh early on and see the evolution of dentistry. And you know, the last five years since two thousand since 2020, everything I do is completely different than I did before.

SPEAKER_01:

You know, it's been a fast time.

SPEAKER_02:

It's completely different. It's not even close. I mean, my all on four practice is different. Uh, even I mean, I've I started my own dental lab. Uh, I'm no longer with Route. Uh, I've got three technicians upstairs, I've got two designers. Uh, we're doing casework for uh other doctors across the country, uh, doing AOX design, same day design. We're milling for people. Uh we're doing high-end aesthetic crowns and and and zirconia veneers. You know, 70% of my practice is AOX, and uh 30% is still high-end full mouth crown and ridge. Cool. Uh it does, it's all green to me. I love it, you know. Uh, and you know, prepping teeth does not, I know it's insulting for a lot of guys, but I love it. I still enjoy it.

SPEAKER_01:

Still cool.

SPEAKER_02:

Uh yeah, I mean it takes me the same amount of time uh to prep a full arch and get them in temps as a dozen AOX. Uh they go out three weeks, we dial on the tents, we get new bites, we uh mill everything out upstairs, and uh I bring them back, sedate them one time, put it all in, tweak their bite a couple times, and we're done. Yeah, yeah, I mean it's not that easy with AOX, you know. So yeah, you're right. It's still a lot of fun.

SPEAKER_01:

Well, I I certainly appreciate that uh the storied history you have and in implantology all the way back to you know really its beginnings, at least as as far as it became widespread in the US. Um, and and I really love that as you tell your story, you kind of tell it through uh all the people that influenced you and helped you along the way. And I think that speaks a lot um to you.

SPEAKER_02:

Well, I stand on their shoulders, you know. I would not be here without these men uh in my life, you know, and the and and the mentors and all the friends that have helped us. And you know, the the tremendous thing now being part of oracle and full arts masters and mod institute is uh the social uh threads that we're on, you know, uh WhatsApp and things like that. And I I get to mentor the kids, but you know, I learned just as much from them. You know, I've got a printer problem or I've got a uh centering of an issue, you know. These kids are all over it, you know, and and I get my uh designer said, Hey, go talk to Dr. So and so. He's got our answer over here, you know. So it's a win-win for all of us, you know. Yeah, absolutely.

SPEAKER_00:

Absolutely. Tyler and I talk about that all the time, how we're we're so lucky to be in the uh implant space when we are, because you know, we get to just stand on the on the giants that came before us. So um, you know, it's a it's a really cool time to be a part of implant dentistry, and we wouldn't be able to be here without guys like you, you know.

SPEAKER_02:

So I think this is a good lead-in to the patient-specific implant or sub-perostal. Okay. I mean, it's a sub, all right. Whether it's patient-specific or you know, I just did an article with Vichy Brahmont and uh North American uh clinics of oral surgery, uh, co-authored with him uh on implantology, and I went really heavy into the history and I named it classic subperiosteal. So we've got CSI and we've got PSI. And um, you know, I I attended some lectures with some guys international uh that were doing the PSIs and promoting different companies and stuff, and very good information. And you know, I actually did a podcast with one of them, and you know, I I was glad to hand the gauntlet off and say, you know, go young man, do this. And uh, but there was something that was missing was all this great information, this research, and I do mean research, published peer-reviewed literature research, RD from Root Lab and from doctors like little John Carmeen, especially Boyd Harris uh in Fatville, that had perfected the mandibular subparous. And they were doing some maxillary subs, but not a lot. But we come in with this PSI and we're like, okay, so we're doing a CT subs. Well, um, you know, Dr. James did his first CT sub in 1970, and from 1980 on, Loma Linda only did CTs, they didn't do a two-stage surgery, you know, they didn't expose the ridge, uh, they didn't do the wash impression on it, they didn't pour that up. They did a CT, and you know, they didn't have stereolithic models. They took mylar and they took each segment and they traced it out, cut it, and then they stacked it, and that's how they made the model.

SPEAKER_01:

You know, wow, I was a much more modern application. I did not know.

SPEAKER_02:

Oh, yeah. Well, I mean, literally, my last uh lecture on subs was 2004 in Hawaii, and uh my topic was three appointment subs. They come in for records, um, you know, and literally we put it in the next appointment, you know, and then we took the sutures out. And it was 2004, it's the World Congress or of Oral Impactology. Lenny Lincoln asked me to come do it. I literally flew the to Hawaii, I did my lecture, and I flew back home the next day. I wasn't even there 24 hours. There were like 12 people. The biggest thing I got from that was ICAT was there. Okay. And I'd been taking all my patients to the hospital, to a Helical hospital scanner, and we're putting dowel rods on them, and it's taking 45 minutes to scan them. And you know, there was one doctor that was hypnotizing his patients to make them be still. And you know, I just say, don't move. And we'd tape a radio opaque rod on their face, check for movement. And uh there was one lab in Colorado that could make a stereolithic model, but uh you know, I was lecturing on that in 2004, and nobody was interested. Nobody, you know, so I just kind of faded off in the sunset and said, Well, I'll still do a few subs here and there, you know, and then fast forward, you know, there's an ICAT there. I'm like, okay, so I'll buy one. I've got the first one in the state of Arkansas, you know, and I start doing comb beam CTs, treatment planning, and all that stuff. And I send my DICOM data, and back then it was on a uh tape, you know, we didn't even have CDs to do it, much less the internet to do it, yeah. And uh we'd send it there, we'd get a model for a thousand bucks, I'd send it to Root, they'd make a replica of it, stone model, and then we'd do the the implant. It was great. I mean, the whole first stage surgery was gone. Uh then you know we got to the point where okay, now I can do the uh I could take the the the DICOM data and I can segment it with my software myself. I can print the model in my lab, and now I can send that to whoever. Uh the last ones that I've been doing, I've been working uh with Nate Farley, Prostatonist in Phoenix, and he and I are literally doing it 100% digital design. We take the DICOM, we we segment it, uh, we use mesh mixer, exacad, blender, we set up our design, uh, we milled them, we've printed them, uh, you know, whatever. But uh they started out kind of rudimentary because the printing process is not as pretty, but uh we've done a couple with the lab, America Stental Lab in uh Kansas, that uh we did the digital design, sent him the STL, he printed it, he invested it, and he cast out a uh Cobalt Chrome aluminum, and it's beautiful, the classic tripodal mandibular sub. And uh, you know, so there's lots of things going on with the technology, and you know, I'm currently working with a couple different international dental implant companies that are doing subparalists and said, hey, can we tweak the design? Uh, can we do this? Can we do that? And I've been very well received uh by you know one group, the other, these kind of crickets, you know. Uh but the big thing that I want to bring in is all this stuff that we learned in the 80-year history of subperiosteols doesn't just go out the window because we can print it out of titanium and put some screws in and say, oh, it bonds to bone. Okay, yeah, but you know, the classic sub set on top of bone, basal bone, hard bone. Uh settling was the big issue. You know, if you were on the maxilla, it's membranous bone, it's thin bone. Uh, if you were on the alveolus uh on you know, division A ridges and misclassification, they resorbed. And so the implant settled and had movement. And there were a lot of design flaws early on. You know, I mean, Gustav Dahl did this in 37 and he did an interval impression, x-rays, and probing, and he scraped that model and he said, okay, this is what we're going to make a sub on. Uh, you know, Kerskoff and uh Bergman and Goldberg, uh, 4851, they first did the first two stage where they did a direct bone impression. And, you know, with direct bone impressions, a lot of people didn't reflect enough, so they didn't get uh a good lateral loading of the implant. It was all crustal, so that's where you see the tabletop designs on the early subs, which all fell. You know, they were failure, and you know, one of the big things like 1970, uh, Dr. James from Omalinda, uh, they had like two different patients who had donated their body, and uh, there was a doctor out of Puerto Rico that had done uh histology on it, but they saw suspensory ligament out of dense collagenous fibers, and you know, he postulated that subs were held in the suspensory ligament and that compressive forces or crustal loading was you know osteoclastic, and that it loaded the mandible laterally on the lateral ramus or in the symphysis, that it would be more off-axis or tensile type loading and it would promote bone growth. And used to the first mandibular subs would have struts on the lingual, and when the patient's mandible opens wide, that it's it's it gets narrower and they would have dehiscence there and issues there. So, you know, with James' uh early theories about this, we changed where we loaded the implant and success rates went up. Uh, you know, we saw and today in the current PSIs, we see a lot of abutments coming out of the first and second molar regions on the mandible. Well, what do you have down there? You've got a buccinator, you've got the myhyoid, you've got very low bone volume, very thin attached tissue in this area, and it's uh it's a problem for recession and infection. Well, you know, root uh and and Lincoln, funny story. Lincoln was doing a direct bone impression, he didn't want to expose because he had a totally distant nerve. So he exposed both ramus, he spokes the symphysis, does three different separate impressions, and then one impression of that, sends it to the lab and says, make me a sub. And at the time, you know, the framework went all the way from ramus full. And uh Rob got it and he looks at Danny and said, What do we do? And they finally decided, well, we can do a big connecting bar, a mesobar from the ramus to and come out of the ascending ramus with one strut, come to the canine and have your other permeacosal strut and go around. So it's a continuous bar all the way around. And they just put O rings in it and an overdenture. And um so they sent it back to Lenny and Lenny. Put it in and loved it. Worked perfect, you know, and it got the permucosa post out of that molar region. So uh Lenny was on the stage like a couple months later at one of the big implant meetings talking about his new tripodial sub that he designed, and Rob goes back kind of upset to Danny. He's like, You're gonna let him do this, take credit for our design? And Dan's like, well, of course I am. He said, if it works, we're gonna sell a ton of them. And he said, if it screws up, it's all Lenny's. Well, it's all on him. I mean, you know, Dan Hillary was a very, very brilliant man, he's a great businessman, but moreover, he did some tremendous work in our field, and you know, that shouldn't be lost. So, you know, today we see very, very heavy uh thick substructures, they run it through finite analysis, element analysis. And I'm not a biomaterials expert. You know, we had one in Alabama Implant Studio, Jack Lemons. You could always run this stuff by him. But yeah, if I could talk to Jack today, I said, Jack, yeah, how thin can I make a titanium implant compared to the old chrome, cobalt, molybdium, vitatium implants? Because you know, it's it's it's a stronger metal and it's got better flexor and all this other strength. But you know, the the old classic subs, they were all designed with a lattice snowshoe type structure over the ramus and over the symphysis to spread the occlusal loading out on remote areas. And some of my lectures I talk about subperos being the remote first remote anchorage implant, you know, and so you didn't want crestal loading, you wanted lateral ramus, you wanted symphysis, areas like that, well away from your permecoastal areas. And you know, I literally have not lost but one mandibular sub or out of the approximately 100 I've done. And I chose to take it out because the patient was moving. And uh, you know, I started having better luck with shorter root form implants, and I just popped her in some root forms and I sent her to Texas to be free, you know. But you know, with the large frameworks that we're seeing, and they're running through FINAT, and they say you got to do this and you gotta do that, and and everything, I get it, but there's such a thing as biocompatibility or biomechanical design. And when you place an implant on bone, whether it's bonded to bone or not, you want the periosteum to reattach to the bone as quickly and as well as you can, as fast as you can. And so, you know, those struts, uh, a lot of them that I see are very bulky, they've got rod angles, they're in the mucosa. And, you know, first lecture I saw, PSI lecture, I was sitting there and I'm looking at the design and said, it's gonna dehys here. One of the guys uh sitting next to me, Bo Wright from Kentucky, goes, How do you know that? Just watch. And about five slides later, we get into complications and there's a dehiscence there, and the tissue won't it won't tolerate that bulk. And so we really need to debulk these things. We need to not crestally load. I see a lot of mandibular subs that are loaded in the molar region with three per mucosal posts coming out of the molar regions. And you know, if you just take a little look back where history was and what designs proved out to be very successful, modify the the PSI designs, use titanium, you know, use printed uh techniques and things like this, uh, I think we would see success rates uh improve. I really think that I I I get a lot of complications in my clinic because I've been doing this a while, and I've seen some really ugly, you know, PSIs uh out there. And I think that complications are definitely underreported. And when you go to literature, you know, we're getting two-year results. I don't see anything long term yet, you know, with 26% complication rates at two years. And uh I just think that we really need to take pause at what we're doing here and see what used to work, see if we can implement those uh uh developments and and and concepts into the to the new concepts.