SPEAKER_00: 1:19

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

SPEAKER_01: 1:22

Storin Poppy, and you're listening to the Fix Podcast, your stores for all things implant dentistry. And welcome back to a special episode of the Fix Podcast and the All In, All On X podcast. So if you haven't heard of this show, um it's it started fairly recently, I think like early September, and it's already really taken off. It's gotten a lot of traction. Dr. Adam Hogan, I've I've we've interviewed him in the past, and uh, you know, he's made a lot of waves in our industry and he's talked already with his show, talked to a lot of prominent um dentists and clinicians out there. And uh he's all about going all in, putting all the chips on the table. And uh I would love to hear from him uh uh more about that, more about his philosophy around the podcast. We're gonna talk all kinds of stuff. We have lots of topics to cover here. Um, but I want to take over because this is gonna be uh a simul post between both shows to help you know spread the wealth and talk more about full arch and the real world um behind that. So, Dr. Hogan, uh welcome to our show and thanks for having us on yours.

SPEAKER_03: 2:18

Yeah, it's great to be here. And um, yeah, what I think what you meant to say was welcome back to the all in, all on X pod, right?

SPEAKER_02: 2:25

Okay, all right.

SPEAKER_03: 2:29

You guys are the wily uh veterans of pod. I think I'm the veteran of dentistry, and I think we'll make a great, a great show.

SPEAKER_01: 2:36

Yeah, absolutely. Yeah, um, so yeah, just to start, could you uh talk a little bit about um who you are, and we'll talk about who we are, of course, and then um you know have that kind of lead into your reasons for starting the show and what it's all about and the kind of messages you're trying to get across.

SPEAKER_03: 2:52

Yeah, yeah. Well, it's good to talk to you guys again. First of all, I think we we did talk a few years ago on a different pod. Um you guys were working under a different name. But yeah, Adam Hogan run full implant choice in Virginia Beach, Virginia. It's a full arch implant only practice here and the Atlantic Implant Institute, which um I'm really proud to say has a very comprehensive training program for full arch, um, very methodical approach to learning full arch in a five-part series. Um, and then we've got an office uh lab, Seven Cities Dental Arts, and now we've got the all in, all on X pod. Yeah. Yeah. What about you? You guys have nine offices.

SPEAKER_01: 3:31

Yeah. Yeah, yeah, yeah. Yep, yeah. So yeah, it's uh our we're we're full-time content creators and we do some different stuff aside. Um but uh but yeah, so Soren and I, and uh, we have a third partner who's been on the show a few times, Dr. Caleb Stott. Um, we are uh the founders of Smile Now Donald Group. And so we've got nine offices um mostly concentrated in the Pacific Northwest. We do have um some as far east as Milwaukee, um, but we're focused on implants, of course. We do a whole lot of fixed full arch. It's probably about 85, 90 percent of the production in our offices. We also do singles, some overdentures here and there. And uh yeah, I mean, we we've been doing this uh a while. We we all of us have several, I mean, probably you know, six or seven hundred arches under our belts. And, you know, we're we're still learning all the time, still getting humbled. That's kind of the world around full arch. And I think that uh, you know, we've got such a tight-knit and niche community um being full arch dentists, and um it's really important to keep the conversation going and keep things um from being adversarial. I think we want to spread the wealth and talk a lot about um, you know, the realities of this. I think it's very easy on Instagram and social media to make full arch look super sexy and attractive and make every new grad think that's exactly what they need to be doing, and all they need to be doing. Um, but we want to, you know, help engender a more comprehensive understanding of what this is and the real ramifications of what we do and um you know help ultimately be a rising tide that'll lift all boats and raise the clinical quality across all the people that choose to do this. So um that's why we started the fixed podcast.

SPEAKER_00: 4:54

Yeah, and uh I'll I'll uh piggyback off of that. That part of the reason that we even started Smile Now in the first place was because uh we came from a background where we're where we were training doctors that uh probably shouldn't have been where they were, like doing full arched way, way too early. Um, and we saw a lot of nasty stuff that uh we were wasn't in our you know um best interest or what we wanted to strive for clinically. So just uh we decided that when we started Smile Now that we were only gonna bring on doctors that had good experience, that were gonna provide optimal care for our patients, and we didn't want our offices to be like a training ground for new grads coming out of school.

SPEAKER_03: 5:36

You bet. I think I'm I think I'm kind of uh aware of uh some of the complications you guys were having. I think it's a small world and there's a lot of a lot of talk and buzz out there. Um I commend you guys for trying to take a more responsible approach. Nine offices. I mean, that's um how'd you get started in that? I mean, I guess you had a background through the previous experience, is that right?

SPEAKER_00: 5:59

Yeah, yeah. So we um at our last experience, we were in charge of uh all the equipment orders, supply orders, um, starting the offices, training the doctors. So for us, uh the transition was pretty pretty straightforward. You know, the biggest thing, I think, the most difficult thing in this business, right, is marketing properly. It's getting patients in the door, right? Anyone can can find a location, get the supplies in there, get the equipment in there. It's not easy by any means, but once you have a system down, like each one isn't isn't too bad. The hard part is making sure patients come in the door and then keeping that provider happy because I know a ton of different um DSO groups that have tried to make it in the implant space and they bring on super high quality doctors, but then they just don't, the doctors are promised all of these reps and they just don't get them, right? So um it's a balance between opening those offices uh in a in a way that you have top-of-the-line equipment that the doctor in the office is happy, but then also making sure your marketing is at the very, very tippy top to get patients in the door, keep that provider happy, and keep the office running well.

SPEAKER_03: 7:07

Yeah, I commend you. That's crazy. And you know, it's all a people game, right? Like you got nine offices, you better have nine doctors just like you or better. Is that right?

SPEAKER_01: 7:18

That's the idea. I mean, these are these are people that we've gone to courses with. Uh, a lot of them are ones that uh we've known for quite some time or have been recommended to us by, you know, people whose opinions we really trust. And um, you know, we've not let the offices go ahead of the doctor, I think. You know, for us, we've it's always been about making sure we had the right doctor in the right place before we really hit go and step on the gas. And, you know, that can really get you in trouble when, you know, horizontal expansion and just starting more offices is the only goal. And the doctor thing is just kind of something you have to do to fill that space and you get this sort of like warm body mentality. And uh, you know, that's just not something we wanted to do. And, you know, from the very beginning, we said we look, we don't want to grow super fast, we want to grow sustainably, we want to do it responsibly and have good doctors in place. And, you know, yes, we did get up to nine offices in a little over a year, and that is really, really fast growth. Um, but we do feel strongly that we've done that responsibly and uh we stand by the the clinical quality of what's coming out of there. I mean, we we go in and we audit charts and we look at the kind of work that's being done. And, you know, when things do happen, we're you know, we're all clinical, we'll we'll go fly in and fix a case or um help out if someone's trying to go to the next level. We're we're there to support them there. And you know, we've been careful to make sure that we're not getting out over our skis and and creating more problems than we can solve. And um, you know, if we start to get a little overcapacitated there, then we bring on more infrastructure. And I think that's really the balance is just making sure that the clinical quality is there because that's something we've really staked our brand on. And and that's just doing it not just at par, but you know, above par.

SPEAKER_03: 8:41

Yeah, it's so huge. You know, it took me probably 15 years to build a reputation in the town, you know what I mean?

SPEAKER_01: 8:48

It takes no time to ruin one, right?

SPEAKER_03: 8:50

And it takes five minutes to ruin your reputation. That's right. I I always tell people, like, you know, you can fool the public for a big maybe two years and maybe hang on to your business for five, but if you're not doing good work every single day, that's it, man. You're done. There's like a doctor across town that you know tried to parallel me and you know, and not he's not even a blip on the radar anymore because of the quality of work and what was getting done, and you know, that kind of thing. So you got to be consistent, you got to be there for patience, right? I mean, that's you how do you not get over the tip of your skis, nine offices in 12 months? Like, I mean, do don't you feel like you're in a free fall?

SPEAKER_00: 9:29

I will say that three of the offices were the partners, and we all were like very yeah, that's good. Yeah, and and I think and I would say the nine offices were over were over two years, not 12 months. Um it was 24 months, we're at two years right now. Uh so we did we did four, four or five the first year with three of them being ours, right? So those ones were pretty straightforward for us to run. And then over the last year, we've done one a quarter. Um one a quarter is a little bit more sustainable. Uh, don't get me wrong. I mean, there's there's days that we're working you know seven days a week and we are grinding. We luckily me and Tyler don't have children. We're able to we're able to work basically twice as much as as you know, some doctors are. Uh right, but you know, it's for me, it's really about uh the quality of that provider. For example, the last doctor that we hired, Dr. Ramsey Warner, um, he was was working at an office in Denver here for quite some time, and he had probably done maybe 30, 40 arches. He has been to Orca, he's been to um all the implant pathway courses, he's done Bernardo's course, he's he's done the whole gambit, every single course, you know, that that solid salt Clark Damon's course.

SPEAKER_03: 10:42

I haven't seen him.

SPEAKER_00: 10:44

And and we're gonna have to send him to to Hogan's course now. Yeah, uh and and basically uh um Hogan, are you affiliated with with Orca at all? I thought I've seen you in some of their stuff.

SPEAKER_03: 10:58

No, no, I'm not. I've separated myself from uh that group. Uh yeah, we can get into it a little bit, but you know, they got some good things going on.

SPEAKER_00: 11:07

Yeah, yeah. Regardless, the the basically he got he went above and beyond to get the good experience, get his groundwork under him, and we were comfortable vetting all of his cases, making sure that you know he did quality work. And that's who is the doctor that we want to hire on to our offices. Yeah, you know, not somebody that's that's been like, hey, I've placed an implant at a at a weekend course.

SPEAKER_01: 11:29

Yeah, I think let's do some bull arches. It's it's one thing to take on the responsibility of the business itself and getting patients in the door and making sure the right staff and things are there. It's a whole nother thing when you're having to hold the hand of somebody clinically. Um, when you're trying to do both of those things at the same time, that's when you're asking for a house fire. Um, so for us, you know, having that solidarity of just knowing the people that we put in these offices know what they're doing on the clinical side, and they can really focus on making sure that they're picking the right cases and they're doing them correctly and they're setting them upright and giving them the support there. Knowing that they're not the liability there, and and most of the responsibility is on us just to keep the business healthy makes it a lot, a lot simpler for us. And there's there's a lot of our offices, I would say, you know, generally when they're first getting started, they need more support. We're going to be there in person. We're there for those surgeries, we're there, we're licensed in all of our offices. Um, so we're able to make sure that those first few cases are super successful until you know that that doctor is, you know, very comfortable in their environment. They're cooking in their own kitchen. And then, you know, a lot of times what happens is things start to get a little bit quiet. You know, we look at the cases, they're coming out reliably, we're doing, you know, 15 to 25 arches a month in these offices. We're not hearing a whole lot of um issues coming out of them. And then, you know, when the clinical side of things starts coasting a little bit and we can just really focus on the business, it it gets easier to scale. And it's not like we're running around with our heads on fire. So um, yeah, it's just super important. And I think that for us, you know, the show has helped a lot um having visibility, you know, as I, you know, I guess uh I wouldn't call us experts in the field. Perhaps we are, perhaps we're not. That's for other people to decide, I suppose. But being people that talk a lot about this and engaging with people that want to learn about full arts has helped us find so many people who are very capable, but just didn't quite have the right opportunity to really focus in on this. And so um I think the the beauty in it is really just the betting process and making sure you're you're getting the right people in the right place. And it's like you said earlier, Doc. I mean, it's you know, it's it's it's a people uh economy, right? Like it's all about who's in those positions and and making sure that you know they can run things on their own, you know, with our support.

SPEAKER_03: 13:22

Yeah. No, absolutely. I mean, if you got the people in play, I mean, that's your most vital asset, the people, and that's the hardest piece of the puzzle. You you can go out and buy equipment, you can buy locations, you can buy a marketing plan, you can buy advertising, but you know, having the people in place to make it run, you know, people come to me all the time, like, hey, can you help me get set up on a um on a project on an office? And I'm like, sure, you know, we can do that. You know, I I can do consulting for you. Yeah, um, and they're like, Where do I I want to advertise? And I'm like, wait, hold on. Do you have the people in place to handle the calls before you start blowing 10, 20,$50,000 a month? Yeah. They're like, I mean, would you have standard operating systems? You know, do you have it all the pieces? Who's who's gonna do this? How are you gonna funnel it? What are you gonna do when they get in the office? They're like, Oh, I don't know. I thought people were just gonna call the front desk, you know, and we just slide them into surgery on Wednesday.

SPEAKER_00: 14:12

Like it's very easy to to waste money on advertising if you don't have the proper framework set up to, you know, a lot of these patients don't need to be called once, they need to be called three, four, five times, right?

SPEAKER_03: 14:25

Twenty, four times. Yeah, yeah, yeah. A lot, yeah, a lot. So are you let's get into AI. What are you guys doing for AI?

SPEAKER_01: 14:33

You know, I mean, we've toyed around with it a little bit. I think we've had different experiences with it. Um, we pretty much anything that we look to roll out with a group, we usually start with our principal offices, so the three of us, so we can very tightly monitor how that's performing and see how it's working out. And we did the whole like AI uh receptionist thing, you know, um, because one of the challenges is, you know, we especially with our advertising, you know, we do TV and stuff and we have odd hours, you know, on the on the weekends and the early mornings and stuff like that. It's very hard to capture all those calls. And, you know, if you miss a call, it's it's usually gone. Like a lot of times you can't get a hold of a person again. And so AI was kind of helping us uh scoop some of that up. Um, and I think there was there's been some marginal success in us tuning that and really getting it to convert into appointments and at least consults, and then we can follow up in person. Um, but uh, you know, for us, I think the the human element is still really important. I think people really value that, especially uh, you know, older generations, which are, you know, comprise a significant portion of our you know patient population. Um so AI can be challenging in in those kinds of ways. I think if you try to incorporate too much too fast, um, it can really work against you. And so we're trying to find that balance where it supports us, but we're still able to have that human element and people are talking to real people. I think it's still important. I agree 100%.

SPEAKER_00: 15:48

Yeah, we absolutely we've played with the AI chat bots, you know, we've played with uh the AI scheduling, we've played with AI phone trees. Um, and ultimately what what we've kind of like consolidated was um it can be useful for hours where people aren't working, right? Like if if if people are trying to schedule a call from 11 p.m. to 4 a.m. or whatever it may be, sure, you can give it a go. But overall, um, most of our patients are 60 plus, right? And and that's the people I want to be treating, right? I don't want to be taking teeth out of people that are 30, 40. 60 plus is is great. And a lot of those 60 plus population, we will we've gotten we've gotten a ton of uh data that they'll call up if they hear one AI person, they hang up right away. So yeah, and so we've kind of like moved over it back to making sure offices have proper trained front desk staff that are willing to vet these calls and then keep them in place so they can continue on. But I'm really curious to hear if you've had any success with AI.

SPEAKER_03: 16:48

So I think it's still building. I think um, I think it's way oversold right now. I have I have looked at in the last eight months, I have tried to partner with like not partner, but bring in like four AI systems, and people and they they get sold as oh, it's ready, it's so good to go. And then we get it, we get this garbage product out of it, and they go, Oh, well, you have to train it. And I'm like, your product isn't even developed yet. You want me to pay for it and you want me to build it for you, yeah, you know, like and that's been the common theme with everybody, and um, and so now, and we're working with an uh fourth or a fifth company right now that I think this guy's got it all dialed in. We're trying to get it installed now, and I don't really want to give a shout out because I don't want to endorse it before I try it. Sure, sure, sure. Um, but it's been very disappointing the results, and I think my opinion on it is you know, you can't stop the 65-year-old from calling you on Sunday morning when you're closed, you know, or Saturday morning, you know, when they're up and they see uh you guys are on Randy Alvarez, I'm on Randy Alvarez, and you got that Sunday morning TV show going at 5 a.m. and they decide I'm gonna call the office, and then they get disappointed. Like you've got to have it answered. So I don't know that there's a right answer because I've tried call centers and they're out, you know, in India, the Philippines, or they're in Africa speaking the Queen's English. And those people, and I've had them in the United States too, and those people are never really invested. If you listen to those calls, it's appalling. I I'd almost rather have a computer do it.

SPEAKER_01: 18:15

Yeah, if it's awesome.

unknown: 18:18

Yeah.

SPEAKER_03: 18:18

So it's like you got to answer the call, or they're or they're not calling back or picking up. I think that you have to have your AI pro bot say, Hey, you know, this is uh Susie. I'm an AI bot, but here I'm I'm here to help you because this is a family run office and we're not in right now, that kind of thing. So they know exactly what you're talking to. I like that phrase 100%.

SPEAKER_00: 18:36

Setting expectations like directly on the on the AI call is smart, I think.

SPEAKER_01: 18:40

Yeah, and I I think that you know, if we're having this conversation two, three years from now, it probably sounds very different, right? Like AI is developing so incredibly fast um and getting much more sophisticated. I mean, we probably I mean it's very debatable when AGI comes around, like that could be five years, it could be 15 years, it could be never. Um, but more than likely they are going to get sophisticated enough to where we're everyone's gonna be using it. If you're not using it, you're behind. But I I totally agree that I think there's there's a little bit too much excitement, too much hype, and um, you know, we're believing in it a little bit too much too early. And it's just like people are trying to be first to market with this, you know, AI receptionists and stuff, and just convincing you to throw a bunch of money on it. It's just not there yet. Um, and and the people element just it just matters, and I think it's gonna matter for longer in our segment than it will in others.

SPEAKER_03: 19:25

Yeah, you can use AI to build your own program. You guys could do it it yourself. I mean, I've looked at it myself, I don't have the time, and you're gonna have all these millions of people trying to build these AI, and you're gonna you're gonna have to see what rises at the top, and you know what becomes the number one. And I think it's almost like a game of like TikTok reels like what's the magic code, or is it just like accidental? So you got 50,000 people out there trying to make a dental AI answering service, and they none of them that I've seen have it yet. And one of them's cream's gonna rise at the top probably in a matter of a year or two, I guess.

SPEAKER_01: 19:57

Yeah, you bet.

SPEAKER_00: 19:58

I agree with that. We're uh we're big advocates for letting other people test it out, and then once it's working fully, then you know it comes into our office. I think we did the same thing with with a lot of like the digital and photogrammetry stuff.

SPEAKER_03: 20:10

Sounds like a dating strategy, yeah.

SPEAKER_00: 20:14

I mean, with with digital, we were we were definitely like slower on that train. We were doing analog for a long time, and then once photogrammetry came along and a lot of the other um things to make the digital process a lot more simple, we're like perfect. Now is the proper time to jump in. We jumped in and we probably had a hundred less issues than the people that were you know trying to to do a perfect scan and mesh it without photogrammetry and and make a you know arch out of that, which didn't work. So I think people I agree AI will come around, and once it's perfect, that's probably when we'll start incorporating more.

SPEAKER_03: 20:50

Yeah, digital dentistry. It's crazy what people think of when they think of digital dentistry. Um, I'd like to get your opinions on this. Yeah, uh, because I educate on digital dentistry and digital full arch. Um, give I'll take you back a little bit. I mean, I've been doing this 20, like I did my first all on four in 2003. Okay. Miserable failed experience, by the way. Um, I don't think the technology and the workflow was really there to even support it on a regular basis until maybe 12, 10, 10 or 12, right? At least it, you know, for most people in office. That's when I got my first printer and I started doing my own exoCAD design and stuff like that. Um, and it's just really taken off since the advent of true extra oral photogrammetry. I want to say extra oral photogrammetry, not intra-oral photogrammetry. I think the word photogrammetry in the last um 18 months has just been like a trademark stamp, like, oh, I use photogrammetry. No, you don't. Like, you're just using that word, you know, it's not you're not doing that. Um, we can have that discussion. I can go down that rabbit hole all day long, you know. But when I was in analog, I was gonna quit full arch, man. I was doing this stuff. Well, you know, I mean, doing one arch a month, like 2012 or something like that, no problem. Trying to do like 10 or 20 arches a month analog, you know, like you know, like yeah, just right in the jugular right now. I almost went back to general dentistry before photogrammetry came out. I was just like sick of it, you know. In the office all night long, my wife's like, you gotta choose, you know, the office for me, you know, like you know, porn models. I used to have these bins that are they were like 15 inches. You could put an articulator in the bin plus maybe 12 models, and these bins were overflowing. Oh my god, you know, oh it's a mess. Couldn't imagine, but people don't even know right now. Like, I was at a study club last night, a local study club. Not gonna say who, not gonna say where. The doctor that was lecturing up there um was saying how they're fully digital, and I'm looking at the presentation and I'm like, dude, this is like 15 digital. This is like so 2010, you know, and he believes it, you know, that he's digital. And I'm like, what that you have an inter-all scanner, yeah, you know, like you know, right, like educating the masses, we have to get people up to speed, don't you think?

SPEAKER_00: 23:18

Yeah, yeah. I think uh I think the whole digital world is um there is so much benefit, especially to like things like full arch dentistry, that if you have your proper systems down, you can eliminate not only a lot of issues for yourself, but a lot of issues for patients as well, right? You patients don't want to um to break a prosthetic, come into your office and have to sit there for four hours while somebody is like trying to um put acrylic and make put it back together and then stick it back in your mouth. They want to call up, say, Hey, I broke this, perfect. You print a new set, they walk in the door, place a new one, send them on their way. Right.

SPEAKER_01: 23:58

So yeah, um 15 minutes.

SPEAKER_00: 23:59

And those are the things that I think that it's not only like a it is much better for the clinician, right, but also for the patient experience. And and the thing is, is like educating patients because they they just don't know, right? They don't know that if they go to Joe Schmoe on the corner that just started full arch and he's doing he's converting dentures, right? And then and doesn't really know what he's doing to like somebody else that has an implant center, has photogrammetry, has mills, has 3D printers. Um, they just they just aren't educated in that. And and that's something that I think that maybe we as clinicians need to do a better job at is like letting patients know like who and there I wish it was a better way to properly like review the actual treatment that patients get, right? Because sure you can have 300 Google reviews, but if you've done two full arches before, this is the patient's third time, like you know, third third arch, and they come in there thinking that you're the bee's knees, it can end up in a really disastrous situation for that patient because they might not know how to fix problems that they create.

SPEAKER_03: 25:00

Yeah, you know, truth in advertising, right? Like deceiving the public. This this kind of one of the things I I don't know that it's possible to get a governing board on this, you know. And I hate to say let's self-govern because dentists can be so cruel to each other with all we're not dying. I mean, you know, but like there's a big large DSO practice just moved into my neck of the woods, okay. And um, you know, the website is up, and the doctor's great, nice guy, really great. But the website's up and the reviews, and it looks like the the practice is brand new again. Again, and they've got they brought over the reviews from other cities about the practice, and I'm like, huh, you know, we're not really talking about this practice, this location, this doctor, you know. So, and it's just like and they they put out, and I know competitors in town, they go, I'm fully digital. I'm like, I know you don't have photogrammetry. I mean, like, and I know you're you don't have an in-office lab, and this, and they'll say everything's made here. And I'm like, please, I know people that work there, the only thing you have is a 3D printer, like you know, so the truth in advertising just blows my mind. Like, and I I don't know, I'm just back here, and I don't know that you can do anything about it, but I'm just back here in my own world, just like taking note, like, wow, there's a lot of claims out there, and a lot of claims that people say and this will last forever. What do you think about that?

SPEAKER_00: 26:26

I tell patients straight up every every patient that comes in my door that asks me about that, I tell them we we have no idea how long this is gonna last. Sure, there's a there's a good chance that that zirconia prosthetic I make you could last a very, very long time, right? But the implants under them, those are the ones that aren't gonna stand the test of time. And it really is gonna come down to how well you take care of them. And I can't promise you anything as far as that goes. So I I hate when places advertise that it's gonna last a lifetime because we're clinicians, right? We don't know if you go get your knee replaced, the hospital isn't gonna tell you that knee's gonna last your lifetime, right? No, no, so why are we telling people that these screws in their mouth are gonna last a lifetime? I don't think it makes any sense.

SPEAKER_01: 27:07

Yeah, it's it's irresponsible, but I think it kind of goes back to what you were saying really early on in the show here. Um, Dr. Hogan is you know, you can you can you can fake it for about two years, you know, you can fake it and you can sling arches and you can just keep screwing them in, and patients are gonna seem really happy for about two years. Um, but once all that starts coming back to bite you, like things go up in flames really fast. And we've seen groups come and go, and and they they grow really fast, they'd be making a whole lot of money, getting a whole bunch of reviews, and then they're out. And you and you see the news article about all these abandoned patients. Like this, these things happen. And I think that over time, um, people doing it correctly with the right setting the right expectations and doing the right things to make things last long term and doing things when they're actually necessary, that will stand the test of time. And you just have to stay the course on that. Don't get distracted. I think is the important message.

SPEAKER_00: 27:54

We we're dealing with that right now in our Milwaukee clinic. Um, uh, Eon was a was a group out of Chicago. Have you heard of them, Dr. Hogan?

SPEAKER_03: 28:03

No, I have not.

SPEAKER_00: 28:04

So they uh they had about eight offices in the Chicago, like southern Wisconsin region, and then they just closed all their doors overnight, didn't send the patients a letter, didn't do anything. And guess who who's then managing those patients? They come into our office, right? They come into like the the affordable and clear choice, and a lot of the bigger DSOs, they just straight up tell them no, right? We're like, okay, let's see how we can help you. See, like, if there's maintenance protocols, we're absolutely not gonna like take on somebody's warranty that they would people promise them the lifetime warranty, right? And then close their doors. Right. I'm not gonna do that. It's just yeah, um, but we see it, we've seen it a lot. We've we've helped to manage some of those situations, and it's it's really unfortunate for the patients that are stuck in the middle of it because they they listen to the the providers, they hear that they're gonna have these teeth forever, and that person's gonna be in that chair forever to support them, and then overnight that could be gone, and it's it's unfortunate.

SPEAKER_01: 28:59

And and so much of it is marketing. I I can't I I know I have the conversation at least once a week with a patient that is convinced that they need to do this so they'll never see a dentist again. And and when I tell them that's not the case and there's no magic roll, nothing can be done, they get frustrated, they get mad at me, you know, and and I just you can't take those kinds of cases on. Somebody will, I'm sure it's gonna get done on the road. Um, but uh, I'm having that conversation all the time. I I know the message just getting across, and it's it's uh it's not something we can really reverse. It kind of has to will itself out.

SPEAKER_03: 29:29

I agree. I've seen so many places um close down the the the cheap, you know, the cheap all on four, the quick fix all on four, the you know, fifteen thousand dollar arches, twelve thousand dollar arches, nine thousand dollar arches. You know, first of all, we in dentistry, we know that that's a sham. We know that there are add-on fees later and you're paying for tier treatment and you can upgrade and blah, blah, blah. Right. We know that we know that to be true. But I can't tell you how many times I've seen somebody come in less than two years, things are breaking, need a revision. And my policy typically is I'm just gonna pull everything out and do everything over again. I'm not working on old implants usually. Almost never, I can't remember the last time I did, but you know, you might call that office and just find out the records or what happened, they're closed, they're gone. So, like they're not here anymore. So, I mean, I'm gonna put a message out here on your pod and mine. If you think that you're gonna get rich quick selling 99, 99 arches, you know, work on finding your next career. Okay, yeah, this is existence worth. Yeah, have an exit plan right now. Yeah, have an exit plan right now. And the the ones that do that, the most pervasive ones of doing that, are the ones that are just looking to sell to an equity group in two years. Like they don't care about the patients. They're like, Oh, look at my book of business, look at all my revenue. Okay, I want to I want to sell out.

SPEAKER_00: 30:49

Yeah, no, I agree 100%. And what's what's uh scary about that is there's actually an office, there's two here in in my neck of the woods in Denver. One is twelve thousand dollar zircone, twelve thousand dollar zirconia with sedation, mind you. And generally I'm just like I'm just like, okay. First off, first off, the the second one thing goes wrong with that case, if one implant fails and you have to remake that prosthetic, you're underwater. Like you know, maybe not quite, right? I don't know what their margins are. I don't want to like assume anything, but it's just it's just not sustainable. And it's a it's a right, like you said, a revenue boost where it they can look really good for a period of time, and then the second something drops, it's like it's gonna be a storm.

SPEAKER_03: 31:37

When all the people start coming back with fixes, they're they're not gonna be, you know, they're gonna be in the red on the balance sheet really quick on the you know, yeah. 100%. That's that's the shame. And I think people I think young docs need to know that. I think it's our job to let them know that this is work. I mean, I think there's money behind this for sure, but um you're not gonna, it's not like you're just gonna like hit the lotto on on dentistry. I mean, you got to keep on putting in the work or find someone that will, right? Right.

SPEAKER_00: 32:04

And I and I don't think people talk a lot about like um the the mental strength that talks to it takes to to do these cases. There is a hell of a lot of cases, right, that they probably don't go like on the x-ray, it's like, oh, this case is gonna be a slam dunk. And then you get in there and all of a sudden you can't get torque on your implants, and like it becomes a mess. It's not fun to have to have those conversations with patients after. This is like it it can look pretty on Instagram, it can look easy on Instagram, but there's a lot of days that I you know go to bed and I'm like, man, that that was a tough day. Like I I wish I was you know doing crowns today because I I don't have to tell that patient, like, hey, we decided in your situation that um maybe it's better that we didn't load your prosthetic that day. And and that doesn't happen often by any means, right? But like yeah, when it does happen, it's it's not a fun conversation. It's not a fun conversation to look a patient in the eye and be like, hey, listen, you we've lost a couple implants, we're gonna have to replace those and start from from ground zero again. And that's the stuff that people jump in because they see it on Instagram and they they get to sling a bunch of implants and do all this stuff. But I've seen more, like you know, we kind of talked about before, Tyler and I, we were helping hire these doctors. I've seen more and more doctors come in, do this for three months, and then head back to general dentistry. It's it's the mental capacity, it's the mental strength to be able to deal with the hard cases. That's that's the hard part.

SPEAKER_03: 33:37

Yeah. We are um I'm I'm loving this because of the people and that and that mental strain, but also it's like I mean, that mental game, but also you got the strain with that as well. I mean, I just came into my office, and I mean, let's just say it's a happy experience. And and usually they were they are, I wouldn't do this. It's the people that keep me doing this. But I just came into my office and I happened to bump into a patient, and she just went on and on and on with you know, accolades and laurels for us. And I'm just like, come on, it's like hard to hear, but it's so like where she's identified, starts telling me the history of when she was a kid and all this stuff, and you just get sucked in and drained of emotion. And this is a positive thing, by the way. Um, but you know, think about that how invested you get. If you're I mean, if you're like me, I don't know if you could just turn it off. If you can, more power to you. But think about I go through that in a day when I'm not on a surgery day, I'll probably go through that with like 12 people, and maybe one of those people is having a problem too. And at the end of the day, you just go home and you're just like so tired. Yeah, you know, like it's been a really good day, and I love what I do, but you're like, I'm just I'm checked out, yeah.

SPEAKER_01: 34:47

Yeah, that's the reality of it.

SPEAKER_03: 34:48

Yeah, the work that goes into it is way more than what people think if you're if you're into it, and then you could go the other way and not know any of their names and be cycling through surgeries at 99.99 in arch. And I think that that's a different kind of wear and tear.

SPEAKER_00: 35:03

Yeah, yeah, yeah. Right? I agree. Uh well, I would love to hear a little bit, you know, um, changing gears, just a tad. In the beginning of the episode, you you mentioned, you know, you've been doing this for for 23 years, right? You're a veteran in this space. Like, I would love to kind of hear how full arch has evolved throughout your career. What um, you know, things that you've seen that have stuck, what things you've seen that have changed, and like right now, are we at are we at like the the epitome of the top of the line of full arch? What can change from here? Where like I'm curious what your thoughts are on that.

SPEAKER_03: 35:38

Yeah. Um just for reference, how long have you guys been practicing? Where where do you guys start at?

SPEAKER_00: 35:45

Five years. Five years, yeah.

SPEAKER_03: 35:47

Five okay. So you guys are pretty much born into the digital age, which is great. More power to you.

SPEAKER_00: 35:52

Um first two years we did fully analog.

unknown: 35:56

Yeah.

SPEAKER_01: 35:56

Okay, good in-house lab, lab tech, uh, you know, articulators, stone, everything.

SPEAKER_03: 36:01

Yeah, yeah. So um when I did when I worked with a team of oral surgeons, prostate on us, I had a table clinic presentation. My GPR year 2003, we did we did full arch. Uh, we did all on four. Um, it was kind of the big buzz from 99, 2001. People started talking about it a little bit. Um, even though the science behind this goes back to like 89.

SPEAKER_02: 36:24

Yeah.

SPEAKER_03: 36:25

And um, so I go into my GPR and my process, maxillofacial prostate honest is like you're gonna do an all-on X, all on four. We didn't call it X then. Um, it was a it was an abysmal failure for a lot of. I mean, none of the principles that we know today were known really or talked about. Yeah, um, we didn't have good biomaterials. I think biomaterials kept me from biomaterials and digital workflow kept me from really getting invested in that game much from my private practice days of 06 to 12. It just was like it was a laborious procedure, it was difficult to do. We didn't have all the tools, you know. Multi-unabutments were just becoming a thing, didn't have 3D printers in the office, so it took a lot of work to take someone through this. So in those years, I was more into the mish style dentistry, let's graft, weight, place, weight, load. Yeah, everything was implant level. Yeah, so I did a lot of mish style fixed, um, if that's a term, a lot of removable. And then in 12, I started seeing the literature pop out, maybe 11, 12 with repeated success. And and I'm like, I need a 3D printer. I think my first 3D printer was like 50, 60 grand or something. Um, and I got an exoCAD dongle, I ditched all the Sorona stuff, I got open systems, and I started playing with it a little bit, and then it just kind of like evolved slowly from there. I think 16, I started getting very heavily involved in like full arts, like doing, you know, eight or 10 a month. Um, and then it was like 17. I'm like, this is all I'm gonna do. And when I said it was all I'm gonna do, we still had a lot of analog work, we still had models, we still had verification jigs, we had tons of text, yeah, dust, stone, mess. Everybody was ready, ready to quit and kill each other. Um, and then the photogrammetry came out and it just kind of ever made it and the facial scanning, photogrammetry and facial scanning changed everything. I got rid of 18 or 20 articulators, all the models, all the stone, it became fun again. Where I think we're at, and I'll back up and say this a little bit. You guys had a couple years analog, and I think that that's tremendous. What the people, the doctors I fear for are the doctors, because I don't I don't think they they should be shy of trying to do this. I think they know it's going to be a little harder to learn in a digital world. I think you actually have to you know burn yourself with wax to understand how to design a proper occlusal scheme. I think I feel like it's just the learning's there. So I think I have an advantage of having seen it through more than two decades. Um, but it's difficult if you've never if you've never done that. It's difficult if you've never had an articulator to look into an exocad world or just trust what the lab is giving you. I mean, believe me, the the scope of this practice is so enormous. Um, I think biomaterials are holding us back. I really do. I think that there's got to be something else. I'm I'm a huge fan of monolithic zirconia. And I'm gonna say this for listeners out there. There's a lot of people who think that that doesn't work, and I'm telling you, you're just doing it wrong. I mean, it needs to be delivered a certain way at a certain time, it needs to be designed a certain way, it needs to be milled, everything. You've got to use the right milling software, profiles, everything. And it works very well. And I think that's the best there is out there for 98% of these cases. But I still feel like, you know, when I look at like shrinkage and a in a centering of and things like that, I look at you know, I look at just the process of of making it. I'm like, we are still so in the stone age.

SPEAKER_01: 40:03

Yeah. You know, how in the hell is this actually precise?

SPEAKER_03: 40:06

You know, how in the hell are we calling this precise? Yeah, and we we work so very hard, you know, and they work. I mean, I've got like, I don't know, 3,000 of these things out there, you know, they work, and they're and every time one comes loose and I take it off and I look under it, and I'm like, no chipping, everything's great, everything's fine. Just put some new screws in there, put it back on. It's working, but the the effort that it that we go through to get it is tremendous.

SPEAKER_02: 40:34

Yeah, yeah.

SPEAKER_03: 40:35

No, I agree with that.

SPEAKER_00: 40:37

I think that uh we'll we'll see definitely, like you said, improvements in biomaterials in printed resins, right? So stronger, better printed resins that'll last longer. I also think that I really, really like the idea of us um incorporating AI not into just like the front desk, but also into the lab workflows. I would love a system that could track the occlusion of a patient, right? See where stuff's hitting. Maybe after you deliver your prosthetic, it tracks to see, you know, excursive movement, checks everything for you, and then tells you, like, hey, this zirconia has an X percentage chance of breaking. And those are the changes. Like, that's the stuff I think like you know, if you look at if you look at different tech companies, right? They're a way above and beyond that. And I'm really surprised that that stuff like isn't more incorporated into dentistry. And I would love uh a situation where you could um a patient would come in, you can scan, you know, you you put your implants in, get your photogrammetry, and then the AI software just puts together a perfect full arch for you. Yeah that it that takes into account all of the patient's forces by you know measuring the the guy all the guidance and then creates a process for you. And I think that that we'll probably see that in the next five to ten years, or at least at least corporations. You think two?

SPEAKER_03: 41:58

I think maybe I think maybe two. So I've seen I've seen full arch AI um at work right now, and um and it's not released yet. I think it's just a matter of time, you know, because they're AI when you're doing AI when you introduce it, just grows exponentially. And um, I've I've seen where they're playing with it, I've seen it in action, and you're basically gonna get AI spitting out designs, and designs now are just gonna start approving 10 or 100 sets at a time, and that's the way it's gonna go until the AI is just so perfect, you know, that the you know, so that's coming. In fact, I've had lab techs say, Hey, I want to go learn design, and I'm like, that's fine, you do it anything you want to do, but understand that you might invest a lot into learning how to design over the next 12 months, and then it becomes almost obsolete.

SPEAKER_01: 42:47

But by the time you're good, you're by the time you're good at it.

SPEAKER_03: 42:50

So that's uh you got and I I think that there's still a lot of time left for lab techs to be hands-on with their craftsmanship with porcelain and print resins and zirconia. So the simple fact of the matter is that dental industry is so small. So I was recently out talking to um an AI robotic company, uh medical AI robotic company out in Silicon Valley. And, you know, I was looking at things that we could develop, things that I could be involved in, and because I had some ideas on ways to grow this space. And I'm not surprised I got hit with this. In fact, I kind of knew I was gonna get hit with this before I went out there. The dental industry space is so incredibly small that nobody's really willing to invest, you know,$400 million or a billion dollars into creation of these kinds of, you know, into improvement of this workflow. Um, whereas the company I was talking to, they're heavily invested in, you know, cardiovascular and orthopedic research, AI and robotics for that stuff. But now they're talking, they're talking in the medical space, they're talking to, you know, a trillion dollar industry, you know, because these everything's in network. I mean, everything's networked with hospitals and man HMO's management companies, and there's a lot of money and there's a lot of resources. Like if they develop something, they can easily sell it. In dental world, it's gonna move a lot slower, unfortunately, just because we can't get the dollars behind it to get it pushed through. So that's just the reality of it. I still think that there's gonna be a a good number of decades for humans to be building teeth for now.

SPEAKER_01: 44:28

Yeah, yeah, no, I agree. I think I think we'll definitely be on a lag just because we don't have that uh degree of market cap, right? We're not gonna see the degree of innovation that we see in avionics and in tech and fintech, whatever. Like it's gonna be very downstream for us. Um but yeah, I mean, I think that you know, if we're when we're talking about the future of the workflow, I think you know, AI taking over the human element of design is gonna be huge. We're already kind of starting to see some of the foundational elements of that. Like we've had Dr. uh Sven Bone on the podcast, who's doing a lot of uh some really amazing uh research um out of uh I think he's in Billings Montane. I can get that. Yeah, but uh, you know, finite element analysis of these arches, right? And you can map the occlusion and the you know the software is telling you where you know the high points are going to be, where the stress is gonna be greatest. And you know, it's it's not gonna be long before you you know put the records into a in a program, it's gonna spit out a perfect design. And and it and it's as foundational and stable as it could possibly be. And you know, our design services we work with, we work with JB Dental Lab out of Tempe. And you know, they'll turn around a double arch in 30 minutes, and and I want just a thing, and it's beautiful.

SPEAKER_03: 45:31

But shout out JB, by the way. I'm using them too.

SPEAKER_01: 45:35

We love them here, they're sponsored to go. But you know, the truth is like that's the best in the industry, but in two years, AI could beat the crap out of that more than likely. You know, that's just that you know, and we have to learn and adapt with that. But um, but yeah, no, I I think it's it's an evolving conversation and it's and it's really interesting. That's probably where digital dentistry is going to advance the most. I am curious about your thoughts um on the subject of biomaterials. Do you think the future is additive or subtractive? Do you think that we should really be investing in milling still? Or do we think that for potentially that with printing the biomaterial my biomaterials could get there in a short time?

SPEAKER_03: 46:10

It's 100% in printing. It's 100% in printing. We just need strength the materials and um the cost of those types of printers to come down, uh, hands down, because there's so much waste in milling and you know, just time in milling, it just takes so much longer. Finishing and milling, yeah. Everything can be so much faster in printing. I mean, but in milling, we're still getting better precision. And that's you know, after the whole um process of you know curating the resins and getting them ready for delivery in the mouth. I mean, my problem with printing and printing companies is they talk about this degree of accuracy in nanometers and um uh micrometers and everything, and they're just like it's not that easy of a science to predict, like in vivo, in the lab, in you know, to equilibrate and calibrate across the industry. It's not that it's it's the fact is it's a range, yeah you know, and if we really look at it and we look at that studies, sometimes it's a little disappointing. So they've got to get better in accuracy, they've got to get a lot stronger in materials for sure. But I think add additive manufacturing is definitely the way of the future. I mean, oh, I mean, we're gonna see like space stations go up on the moon through additive, you know, engineering.

SPEAKER_01: 47:25

We need to only look at those other industries that have that kind of money behind them, right? Like they can print houses, right? Like they're printing metal, like all these things. It's not like we're just restricted to nano ceramics, like that's just FDA-approved stuff that's filtered down from other industries that innovate a lot faster than we do. Like we can see the future, it's already here just in other industries. So I totally agree with you. That that's been my take for quite some time.

SPEAKER_03: 47:45

One of these days, okay, in in 5,000 years, they're gonna dig up our bodies and they're gonna find, you know, zygomatic implants, pteragoid implants, and a zirconia restoration, all the you know, in these humans, and they're gonna go, and then they're gonna pull up the Egyptians with their gold teeth. Yeah, and they're gonna go, they have they never got any better. They're like the same people.