The Fixed Podcast

Navigating Full Arch Challenges: A Talk with Dr. Sean Lan: Part 3

• Fixed Podcast

Share episode

Use Left/Right to seek, Home/End to jump to start or end. Hold shift to jump forward or backward.

0:00 | 53:59

What if your membrane actually stayed put and your grafts healed the way you planned? We sat down with Dr. Sean Lan to map a practical path from soft tissue basics to hard tissue confidence, focusing on the decisions that make full-arch treatment predictable rather than precarious.

We start where results begin: donor thickness and visibility. Sean explains why 3–4 mm palatal tissue unlocks pedicled options, when a free CTG is the better bet, and how loupes transform half‑millimeter judgment calls. On maxillary implants, we compare buccal soft tissue strategies—pedicled wrap to bone vs tack‑on CTG—and share when a large palatal flap after reduction can be repurposed for added volume. Stability threads through everything: quick transosseous anchor points, when to suture to abutments, and how to get tension‑free closure with thoughtful flap advancement.

Then we shift to bone. Think “wet sand in a cup” for within‑contour grafts, and why going outside the contour changes physics, risk, and membrane demands. We unpack buckle veneer grafts, sticky bone myths, autogenous techniques like split bone blocks, and realistic membrane choices guided by PASS principles. If you’ve ever fought a floating membrane, you’ll get step‑by‑step tactics: periosteal slings, apical tacking sutures, fixation screws, double‑membrane shortcuts, and using implants or transosseous holes as smart anchor points. Sean also shares a practical cortical plate save—his “poor man’s plate”—to avoid over‑reduction and set up a site that later needs only soft tissue finishing.

Mandibles get honest airtime: fewer escape routes, more muscle pull, higher stakes. We talk training that actually helps—Pink Bible, Zucchelli’s volumes, selective live courses—and how to build reps ethically. Zygomatic implants enter as a necessary but rare tool, best learned with supervision and careful indications. We close on subperiosteals in the most atrophic jaws, urging product decisions to follow biology and evidence, not marketing. Sometimes the most patient‑centered answer is a bar overdenture instead of “fixed at all costs.”

Subscribe, share with a colleague who wrestles membranes, and leave a review with your favorite stabilization trick—we’ll feature the best ones in a future episode.

SPEAKER_02:

My name is Dr. Tyler Tolbert, and I'm Dr. Soren Poppy. And you're listening to the Fix Podcast, your source for all things implant dentistry. Okay. And so you bring up a good one there too. So we were just talking about transporting tissue from the upper to the lower where it's deficient. Let's say we're just on the upper and we're deficient on the buckle of, say, number 13 or something like that. You know, you mentioned a pedicle flap. What are kind of your go-to techniques if you're trying to gain some um connective tissue on the buckle of one of your maxillary implants?

SPEAKER_00:

Um, yeah, uh again, it all just comes down to how thick your donor side is. You know, if you have adequately thick, you know, I'd say minimum, like very, very minimum three millimeters. But it's because the the reason is you want if you get 1.5 as a safety margin, like one, it could still probably survive not necros, but like it's so it's so hard to tell, you know. And and and this is why I also advocate for wearing loops for for full arch. Like my not that you have to, but for my preference, I wear 2.5s um and I'm able to see the entire full arch. But I have these ones, and you could just not wear them too, but I you could pop them out and and just not have them. But when you're doing soft tissue, it really, really does help because it it really is you see so much more, you're like, oh my god, I'm blind, like without losing. Um, especially when you're splitting hairs, like you're we're talking about half a millimeter here. Um, and some periodontists will I'm not also extreme to the fact where I'm like, oh, you need a period uh microscope to I'm sure you can see it much better with a microscope, but not gonna happen. Tactically speaking, right? Um, we're talking about applicable things. Like I have loops um from I have these loops that you can pop out, they're magnetic, and so they're not like the you know, the ones that you've seen that can go two, five, three, five, four, five, and you have to rotate it. That those are really heavy. Mine, they can pop out, so I can pop out my two fives. I have three fives that can pop in, or even four fives. That's cool. But I just pop them in and who are those by, just in case anybody's interested. Uh or scoptic.

SPEAKER_01:

Okay, cool.

SPEAKER_00:

Yeah. Um, but yeah, they're great, they're super lightweight. And then when I'm done, I pop the two fives back in. I keep rolling my surgery. Um, but yeah, going back to the original question, like the first question I asked is how thick the donor side is. If it's adequately thick, you know, at least again, minimum three millimeters, closer to four, I feel more comfortable with. Um, you can, you know, one, just take a normal CTG and from the palate and just tack it on the buckle, just like we explained before. Or two, better yet, if it's thick enough for a pedicled graph, then I would take a pedicle graph following the rules that we talked alluded to, and just wrap it around. Um, again, not wrap it around the abutment, but uh wrap it around um you know the bone around the implant and secure it to that, the the buckle flap.

SPEAKER_02:

Okay. And do do you ever do any like ossea suturing with that at all? Do you ever like try to do any maxless osseo suturing for your DigiG's and stuff?

SPEAKER_00:

Okay, yeah, yeah, you can that's one of my favorite ways is it really it ensures that it's button on the abutment, right? And that's the hardest thing. And sometimes I'll like I'll be ah, like uh in my head, it's just like trying to grab the remote with your foot, right? It's never faster. Like I'm always like, man, like I'll save some time, I'll just like suture it to the flat, but like I've gotten to the point where I'm like, it's just always easier for me to make a like a quick little transosseous point with the 701 or whatever, and then I just suture to that, and it's you know, I I I'm sure that's never gonna move.

SPEAKER_02:

Yeah, no, I I think that's brilliant. And do you also um, you know, one that I learned from Full Arts Club, and this is not gonna happen on every case. In fact, it's most of my cases that that doesn't really happen, but let's say you do a whole lot of reduction, you have a massive, you know, palatal, you know, flap, and usually we're just trimming those off. If it's you know long and wide enough, or maybe it could even be like in size to kind of stretch it a little bit more, you can wrap that whole flap, you know, over your multi-unit to gain some some buckle tissue. Do you do that as well?

SPEAKER_00:

You know, yeah, I that that technique is great as well. You know, I just personally haven't been able to use it as much because like I it's not super common that you can't. Right. Like most of the cases that are indicated for FP3, at least the patients that I see, like I I'm not doing that much bone, like maybe it's been a while since I had to chop off more than you know, five millimeters, yeah. Six millimeters. Um, because it most the patients done most of the removing for you already, you know. Um period or just you know, just bone loss, you know, generalized bone loss. Um, but um, but yeah, in cases where there's just a lot of tissue like that, then yeah, that's a great way to do it. I've done it a handful of times. Yeah. Yeah, yeah.

SPEAKER_02:

It's it's probably more common in those patients that maybe should have been talked to about FP1. Yeah, yeah, yeah. Possibly, you know. Yeah, yeah. Yeah. Okay, very good. Um, so that's a fair amount of soft tissue stuff. I think that you know, for anyone that's totally naive to that, that's probably enough to kind of bite off, you know, uh right off the bat here. Um, let's talk about heart tissue. So, you know, there's uh, you know, there's GBR, there's quarity plates out there, you know, people use safety scrapers and stuff like that. Like what kind of heart tissue? Um, what's like our basic tool belt that we kind of need to have to be you know equipped for full large?

SPEAKER_00:

Yeah, let me uh let me try to sharing my screen here. I have like a little diagram that I made. Um just to kind of like this is suggested uh my suggested hard tissue progression. Can you guys can you kind of see it here?

SPEAKER_02:

I can, yeah.

SPEAKER_00:

Okay, the little green boxes. Okay, cool.

SPEAKER_02:

So it'll be a miracle if it makes it into the uh final cut because it's an editing nightmare, but I'm gonna do everything that I can. And if not, I'll provide supplemental materials in the notes.

SPEAKER_00:

So if not, you know, you know, you guys can pull up the article. This is straight from the article. I made it for the article. So yeah, it's all in there. Um, it's almost like cheating preparing for this uh podcast. So I was like, I'll just pull my article. Um but yeah, I uh you know, essentially it's just like how it I just I just think very practically, right? Like how you know, how big is the hole, you know, and um how much out of the hole are we trying to graft, right? So yeah, I always start with you know, start people, and when I on my own path, I just start with ridge preservation, you know, four wall, easy. Yeah, that's like that's a cup, you know. You I don't know if you can still see the see my my you know my screen, but it's a cup. You fill the cup with some sand, and there you go, you know, yeah. Um not going anywhere. Um, and then you start to get to okay, maybe you have like a mild buckle pleat dehistance of three millimeters, and then oh, maybe a moderate of six millimeters, and then oh, complete dehistance. Like, how do I manage that with the membrane? You know, um, but still you're within the contour of that socket, right? That's what's called a within the contour type graph. Um the next one is moving out of sockets, right? Now you're comfortable in those. Um then you move into still within the contour type defects, okay. And what I mean by that is it's it's essentially still got almost three walls, right? I'm not talking about a la lateral ridge augmentation where you're you're over bulking, but if you look at a cross-section, right? Essentially the easiest way to kind of um view it is like just imagine the the more and more you go outside this cup, it's like trying to attack that on there. That's hard, right? If you if you took some wet sand or mud, that was you know, it's it's gonna be hard to have that stick, right? So versus like say this cup was like at a slope at an angle, right? Like this. Um, I don't know if you can see it at all, but say we took cut it diagonally, um, and you try to just fill and um create recreate the shape of the cup, that's gonna be a little bit easier to contain than just having uh uh a cup that's intact and you're trying to slap on something to the side of the cup, right? Um did that make sense?

SPEAKER_02:

No, it does because if that if that ridge has, let's say, kind of a buckle slope to it, yeah. I think it's fairly intuitive that you can pack something on and it's gonna kind of hold its shape a little bit better than just like it's a it's kind of a straight wall and you're trying to bulk that out. Exactly. Ultimately, ultimately it's just about what what can you? I like the wet sand analogy, like what can you pack on there that's actually gonna hold its shape and stay still, right? And I think that makes sense that if it has a little bit of contour to it, it's gonna be a little bit easier.

SPEAKER_00:

Right. Um, and then it essentially all this is is just moving further and further outside of the contour, right? So your next thing would be like a buckle veneer graph, right? Buckle veneer graph is usually, for those that don't know, it's essentially horizontal ridge augmentation or uh, you know, where you're where you're taking just trying to over bulk by about three millimeters, four millimeters. There's no hard number to it, it's just less than a traditional, uh, in my mind, horizontal ridge augmentation, right? So you place an implant, maybe it had like one millimeter buckle wall thickness. I'm gonna try to put on you know PRF, algraph, um, maybe sometimes xenographs uh mixed in there, um, depending. Um, but you just um add a you know three millimeter layer of that with a collagen membrane, secure everything nice and tight. Um is that and and I'm gonna ask that question too, right?

SPEAKER_02:

So, like, you know, do we I think you alluded to earlier, like, do we absolutely need to put a collagen membrane on there?

SPEAKER_00:

So for me, so okay, so bringing this kind of back to like common things that have in Florida, right? Like, we'll go back to the second square within the contour graft. Um I I remember like I think the one of the second or third cases I saw with you, right? We had a really tough canines to take out, and both plates blew out because it was thin to begin with, and they were freaking like 18 plus millimeter long, like or more than that, 30 30 plus millimeter long like canines, like they were like 30. Yeah, they're they're huge. I I I know what you're talking about. They were yeah, the facial the hissons was 18 millimeters, like it was huge, yeah. So, but that's still technically a within the contour graph, so which which for me is that's uh for me, like I like to extract like without breaking plates. I'm not afraid of breaking plates because I know how to fix it, but it's just annoying. It takes time to do it properly, right? Even me, if even it being a routine procedure for me, it still adds surgical time. I'm just annoyed. I had to like now I had to break out of you know what I mean. But yeah, you just pack that site with bone, you know. I you know, hydrate with blood, whatever, PRF, and then you yeah, I I personally like I still like to use the collagen membrane, even if it's all autogenous bone, um just to kind of you know um give it that extra security of the the the you know space maintenance and and also preventing the migration of uh epithelial cells going in there.

SPEAKER_02:

So is I I'll put it this way, it so obviously that's your way, and that's gonna be the most ironclad way, but let's say are there are there a contingent of people, because I feel like I've heard of this where they say, you know, if it's autogenous, if you've got some PRF and stuff, if you're using a sticky bone, you just slap it on there, it's gonna work. Like are there people that are that is there people that are saying you don't need to do the collagen membrane?

SPEAKER_00:

Um yeah, so like let's look at some you know pure autogenous techniques like cori technique, right? Or the split bone block technique. Um for that I know I mean I know for certain based on you know their their decades of research that you don't know, you don't need a membrane. And in fact, that might impede um healing um and blood supply to the area, it might slow it down. You know, if you use it's a cortical plate though that you're putting on there that's a little bit different than sand. Yeah, exactly. But the top of it, right? Unless you're doing like a box technique. So let's just say you're just using one plate and you're leaving the top of that little box of the ridge, it's just particulate, right? So the question usually is do I put something on top that particulate, you know? We know that the the cortical plate's not gonna be affected, it's essentially a membrane, the best membrane we can get. It is a membrane, right? But do we cover the top? And and so you know, based on what Corey uh Corey said, and I had to read his new book, I and and I've only gotten to skim through his uh first book, I think early 2000s. Um, it's just so much to read, but um but from what I gather, most of the people that are doing this say you don't need a membrane, okay? And and their experiences worked now. Um I've also seen select cases. Now, again, we don't know all the details, but I've also seen select cases where clinicians have tried that technique, like, man, like I did get some epithelial uh invasion, and like I had to redo part of the graph when I uncovered. Um, and then that time they used a membrane. And so, you know, for me, when I'm trying out these newer techniques, like for me, when I first started graphing, I'm not gonna go out and just, you know, like for example, go going back to our case, number six with a blown-out buckle plate, I'm not gonna just put autogenous in there and leave it. I don't really know if that's gonna, you know, even though I've read all this, I'm gonna be safe and place a membrane, you know, preferably one that's not cross-link, because that uh cross-link membrane will, you know, technically compared to a native membrane, be impede the blood flow a little bit more. Um, but uh yeah, if you're using native, you know, collagen membrane or or or even sometimes people say PRF is enough, um, for within the contour graft, um, then then sure, I I feel a little bit better putting something there.

SPEAKER_02:

Yeah. Yeah, I think I I don't know if I saw this at Orca or maybe it was at another course that I went to. Um, but they for them, you know, sticky bone is perfunctory on every single case, and they'll just graft every single um, you know, let's say, you know, uh uh defect in the like you're looking at all these maxilli. And if they got you know that sort of like buckle uh you know uh concave area, they're gonna pack that out with sticky bone and just slap it on there in hopes of just widening the ridge, and there were no membranes at all. And so that that's the that was like one of the first times where I was like, wow, you could just like you know throw shit on the buckle plate and it's just gonna heal. Like that that that blew my mind. Like and I was curious what what your take on that would be.

SPEAKER_00:

So so for that, right? So for that kind of indication, it's it's more of a buckle veneer graft or horizontal ridge augmentation was out of the software. I've seen that too, and you know, I you don't really see the CBCT follow-ups of it. Right, I don't, you know, you never do, you never do, you know. Um, so I don't know. You know, all I can say is through theory, I'm just thinking, man, especially in the lower mandible uh uh sorry, the mandibular anterior um region, like you just especially you've not got a lot of SUGO most of the time. Um, and then you got the the pull of the lingual tongue. Patients move this all the time when they're talking. You know, your upper lip doesn't really move as much as your lower lip does when you're talking. I'm just thinking all that movement, you know, that kind of is is not doing great things for you know for our past principles, right? Um, shout out Dr. Home Le Wong, you know. In 2006, he came out with that landmark paper that everyone um cites, right? Uh pass, you know, you know, you know, passivity, angiogenesis, stability, and um oh man, I might mind is blanking here. See, I have to go. Anyways, you want to keep it, right? You need blood and you need to keep it still. Um and um oh, I think the last one's like x like uh exclusion of you know the cells or whatever. But um, but essentially, like I'm just thinking, man, if you don't put a member in there, how does it, you know, what happens when the patient moves? You know, is it really staying stable enough? I don't know. So for me, you know, I'm if it's completely autogenous, I can see it working in uh within the contour graft, you know. But uh if you're talking about like the indication you're talking about lower anterior, which is where we have thin bone usually, um, and you're doing it outside of the contour, uh yeah, you know, like a buckle veneer, I absolutely would put a even if I'm using pure autogenous, I would I would absolutely use a uh a collagen membrane to provide stability, you know.

SPEAKER_02:

Right, right. More about that stability portion. Okay, very yeah. And then um, I know this is kind of an elementary question, but you know, people who are not used to using a lot of membranes, like let's say someone has just learned to approach full arch for the totally graphless technique. Um, how are you securing these membranes? Because that's when I first started using, I was like, holy hell, like how do I? I mean, the whole purpose is just for this thing to stay put, and it's not staying put at all. Yeah, there's no way it's gonna stay in place when this patient is talking and eating and going by their life. So, how how are you securing membranes? How'd you get good at it? What are some little tips and tricks there?

SPEAKER_00:

Yeah, so honestly, since we're since we're talking about the subject anyway, let's just, you know, for hard tissue, let's just go back to the fundamental like skills I outlined before, right? So the honestly, the more like I said before, the more and more I've done hard tissue augmentation, the more I realize it's about manipulating the soft tissue. So that all starts with your buckle and your lingual flap advancement. So um you can get everything night just because you get everything nice and tight. And you've seen this too, mentoring cases, right? Even for a simple like closures of the uh, you know, we're just using simple interrupted, you haven't done any hard tissue grafting, like what happens on the manible, the hissings, right? Yeah, all the good just because you can cinch it down, you know, you see dogs cinch it down really tight. It's I got a really tight closure, you know, primary stuff. Well, it wasn't how is the tension? You know, if you had it cinched down really tight, that usually means that there was some tension on that, you know, and that's why those that's why those the hiss, you know, the very common issue you get. You get a call. Hey, like it was great at week one, but now it's like week three, and now duck, like I'm looking at bone. I'm like, okay, that it was probably a little too tight, you know, um when you first sutured it. So yeah, looking at um a buckling legal flap advancement, looking at um uh mastering how to get those those flaps uh mobile enough so that when when you when you close, there's barely any tension kind of pulling on it, you know. Yeah, yeah, the sutures is just meant to kind of keep them closed at the end, but you can't force them, you know, you can't force them close. It's just like you know, an old suit probably that you haven't worn in a while, and you're trying to zip it up, you know, like if you do too much dancing, that thing is ripping, you know. You know what I mean? I I feel personally attacked. That's your buff, you know. You in your case, you just got two buffs. Yeah, that's um yeah. So that's the first one, right? And that that starts with periosal learning, a um, you know, proper periosteal releasing decision. And um, Urban describes this um perioelastica technique where where you can go through um you um and and advance the uh the tissues. Um, and then so going now going back to your question, you know, how do you stabilize the membrane once you're in there? Well, there's there's tons of techniques, man. Like you can use uh the most common one you hear of is the periosteal sling uh or periosteal mattress. Um, and there's different ways to do this too, but uh I mean, just too much information um for for one for one podcast. You can use periosteal sling. Um, you can do the most often ones that I do is that one. Um, I don't use tax a lot just because you have to go back in. You know, if I can, and that's also me being um optimum invasive, right? Like I'm very comfortable doing horizontal augmentations with just suture tech uh stabilization sutures. So uh there's a technique called software technique written by Dr. Kamat, I think 2020s-ish. Um, I love that paper because he really like he discussed a lot of these, not just the sling. That's that one you hear diamond dozen, but um you hear all these other techniques like membrane stabilization techniques where you actually stabilize the membrane and you tack it to the perosteum, um, uh like in the very apical pocket of your flap. Um, and he also tacks the top of the membrane um to the lingual flap or the palatus. Um, and then periostal slings and stuff like that. So that really opened my mind too of like, oh, like wow, like there's I I thought it was just tacks. Um and so that I think reading that paper more so for the technique itself, but just to kind of get your juices flowing and um uh in that aspect. So uh membrane tacking sutures is my uh my go-to. Um, usually using something um you know, like a long resorbing uh suture like PGCL. Um taps, they're great, you know, and they're faster, trust me. Uh the membrane sutures I rely on them, yeah. Yeah, yeah. If you need if you if you're for prioritizing a faster surgery, because maybe the patient has you know some medical um conditions where you want to, you know, faster surgery is something um that you are prioritizing, then do that. But if it's something that okay, you know, this this can be done now. Obviously, not in the beginning. My first case took me like an hour to get this thing stabilized, but now it takes me like 20 minutes, you know, 15 minutes. It doesn't take that much longer. It versus tax, obviously, it does, but um, for me, I like it if I I like to use it if I can so I don't have to go back in. Um yeah, then uh let's see, and then tax honestly on the lingual are just is they they are tough, you know. Anyone that does this, I will tell you they are tough. Um you have fixation screws now. Most people think of those long ones like five to seven nine millimeters that you use for like the core technique. Um, you can actually use um fixation screws. They're like I haven't used them yet. I'm actually I was talking to uh my buddy Dr. Bolchy. Um he's also in the Full Arch Club, but um about these three millimeter kind of fixation screws that are they're almost like screw tacks, you know, like you it's three millimeters in length, and then you could you screw you you screw them in like a screw, but it's essentially a tack, you know.

SPEAKER_02:

Um they tap they tap themselves in as you're yeah, is their self tap exactly.

SPEAKER_00:

And and for the lingle, especially, I think that's a little bit I now I haven't personally used it, but theoretically speaking, that's something I'm interested in in buying because I want to try it out. Um, all right. So we got the sling, we got membrane tapping sutures, we got fixation screws, uh transosteo sutures, like we said. Like I love using the free fixation point, I don't have to use a tech.

SPEAKER_02:

Um, that's every case, yeah, for sure.

SPEAKER_00:

Um, if you're placing implants, poncho technique, you know, like we talked about, it's a it's another anchor point. I just think of okay, these are just anchor points. Where what can I use as an anchor point? You know, you can use so many things. This is the art part, right? It's fun. Um, and then uh I've seen, I haven't personally tried this like as a technique by itself, but uh Dr. Boozer, if you looked at a lot of his work on like early implant, um his early implant placement technique, um, he does a lot of his grass, honestly. Even some like outside of the contour grass, but just it's called the double membrane technique. And I was like, at first when I heard about it, I was like, oh, what's this technique? It's literally just hydrating a collager membrane, laying it on, and then you take a second one and you lay it on top of that. It's incredible. And it works.

SPEAKER_02:

Now I got two of these things to deal with.

SPEAKER_00:

Yeah, I mean so the material cost is high, right? And you use a lot more biomaterials, right? But like I'm just amazed. I'm like, well, if you're prioritizing a faster surgery, that's so much faster than even tacking.

SPEAKER_02:

Like so, so break this down for me. So the first one that one gets hydrated, it just kind of flaps over the top and is like kind of covers everything, and then that second one it's going. to be a little bit more rigid because it's not as wetted and then that's gonna be the one that closes over. Like is am I understanding this? I this is my first time.

SPEAKER_00:

So right no now I don't want to misquote him. So definitely look up the technique yourself. But from what I you know the early his early work on it like mid you know early 2000s mid 2000s like it's the same membrane. I forget what membrane he uses but you know uh whether it's cross linked or native I forget um but I was amazed like I I I personally don't use it um um because I for me I'm not dr boozer first of all uh so I want to I I want to add some slings like for even just adding slings for me is not it doesn't take long at all um so I just add some slings for extra security you know but I've never relied on that technique alone okay for that and you could argue that you know the downside technique is like well now you have a double layer membrane like uh not that you're impeding blood flow but you're you're definitely slowing it down versus just using a single layer yeah yeah kind of similar to using crosslink versus uh exactly like like for for example like where I would use that maybe is and I haven't but like where I could see it uh maybe you could try it on is like a within the contour graph like buckle plate fracture you just lay it on top lay another membrane be done with it you know yeah yeah I could maybe see that but even then I would just throw a a single sling even would help me feel better about it.

SPEAKER_02:

Yeah yeah no fair enough okay um yeah that's great so I have you so we talked a little bit about securing membranes we talked about some hard tissue stuff are you doing a lot of corey plates have you have you messed around with uh you know harvesting those plates and then and then tacking them on somewhere and do you think that's worth it for someone um to really is that a road someone should go down if they're you know knee deep and and full arch and they're wanting to expand you know what they can do yeah so I mean that's actually one of the and we talked about this too but that's one of the next things I want to tackle is is learning this technique because um and I'll have to shout you out for for this uh coining this term but maximizing Maxilla and managing manable right that wasn't that's how it was yeah yeah yeah yeah because I I when I heard that I was like yup like like a hundred percent like even early on in my full arch journey I was like dude like I'm I'm not doing a lot of these techniques yet but man there seems to be so many like options for the Maxilla and crap for the manable you know there's no backup line if it's hourglass or it's thin like man there's nothing to do but graft or do ridge split or do um you know translingual sometimes if you have the right anatomy for it.

SPEAKER_00:

Rare will sub right like like Dr. Jerick and Picos were were talking about um but there's not that many options you know you have to graft in in those areas or do ridge splitting so those are kind of um I I think in the beginning obviously made it this far um there there haven't been the cases that I weren't comfortable with I I for a fair amount I haven't tracked the number of those but it's it's very low.

SPEAKER_02:

You know so I don't think it's something you can learn right off the bat but that's another progression right like at this point two about two years in placing I'm doing this kind of things like regularly like it it's the point where I'm like yep it's definitely worth it to learn um and also just from a surest point like I that's just the next step naturally um yeah I definitely yeah I've heard a contingent of people that you know go really far down the Cori plate um rabbit hole they get into semi lunar technique um you know they they really just go full on autogenous and that just kind of ends up being all that they're doing they're just trying to do that on virtually any case that needs some type of augmentation so who knows maybe maybe you know we we uh have you back on in a year after you learn some of that and you're like yeah just forget that whole first episode all those all those techniques I'm all autogenous now autogenous yeah maybe it could happen I don't know I don't know yeah but I I think those those techniques are fantastic I I I love to get into some ridge splitting get get a you know piezotome and and and start working on some of those kinds of techniques because I think they're pretty cool like that was like one of the first implant surges I ever saw was actually a ridge split um with a couple implants for like an overdensure or something like that and never never got around to actually doing it and there's definitely some cases where I I uh I wish I had tried to employ that instead of just trying to stick a three and a half millimeter implant into a thin ridge you know right right and and more than anything more than the learning technique itself is obviously that's the starting point right but I I'm always like I that's the that's the beauty of blending the art and the sciences um and another like I love this quote um um I think of the first person I heard her say it was knife sonata um but uh know the rules like a pro so you can break them like an artist right that's good yeah like so so for how does that apply uh you know like for example for the sinus right when it came to a full arch I know it's like minimally grafting or minimal grafting technique um uh but I I saw it out to learn you know I was like immediately I was like I need to take Dr.

SPEAKER_00:

Pico's uh you know sinus course um because his membrane repair technique is he's never had to abort one right and I I didn't take that course to learn how to do a lateral window graft you know the sinus lift I learned that course well yeah it would unlock that for me but more so hey I'm just comfortable in the sinus you know um yeah you know when I was started doing trans sinus with an open window like and and the membrane torque I wasn't I mean yeah it was annoying like I had to you know do the technique a membrane repair technique but I wasn't like oh my god like crap like or all nervous I was just like okay well I I had to put a membrane in there secure it and uh and proceed you know um so it it unlocked another level of confidence you know for me uh be working the science now talking about um like learning core and all that I haven't taken a true Cori plate um but I've taken like I I had one of the mandibles that are a little bit taller but still I didn't want to reduce if I had if I the other option was just to reduce like yeah we've all seen those like pyramidal ridges with like nice like oh do I just remove all this shit until I get down to the basal bone and then I work with that and then restorative nightmares but right and and and obviously I'm early in this journey too because so this this case only needed in one site you know site number 20 you know the the uh the left side premolar um I when I did the alveolectomy of the anterior mandible I just saved that cortical plate I had like a four four millimeter tall like plate saved from that um alveol I just used a straight bur to cut it through um and I called it the it's like the poor man's core technique right yeah all it is is a bone plate and you you know you secure it with uh fixation screws and I fixated around the the buckle the implant um I got great torque on it thankfully I was really praying for that um stability um but yeah got great torque on the implant I secured the lingual plate there with two screws and then I just packed bone around it right and for that case yes I did I know it was you don't they say you don't need to but I placed a membrane a pericardium membrane thinner right because I just it's my first time doing that and I'm gonna I know it doesn't hurt so yeah put it there um yeah you know secure the punch and it it healed great all it needs is uh FGG you know wow yeah awesome so it in instead of reducing the entire manual just for that one you know that one spot I just grafted and you know save that patient from getting all that bone just mowed um yeah but yeah I I think where the value of Cory and and Richblend and all this stuff is so that you can apply it to very difficult situations with mandible. Yeah.

SPEAKER_02:

Yeah I mean that that's really where a lot of this breaks down is like we get so excited about the things that we can do for Maxillas but um you know mandibles just aren't as fun to talk about I think that's kind of the irony of it is like someone's coming to you for like a full mouth restoration you know and like we got all these amazing things that we can do and you're not gonna have any cantilevers on the Maxilla it's gonna be awesome. Uh but your mandible it sucks like it totally sucks. You're gonna you're gonna have some molars in the in the on the upper back they're never gonna touch a thing um and we'll we'll restore you to first pre-molar in the lower have fun right like it's just like this forgotten arch you know but the people want a full mouth solution and we we have to get more creative than just looking for somewhere else to stick a screw so um yeah I think that's fantastic. So you kind of so I I love that you alluded to the Pico's uh science course you you've had a lot of great feedback um for that that's something I'm probably looking to do this year as well.

SPEAKER_00:

Um what are some other courses that you'd recommend for people to start diving deeper into soft tissue hard tissue um and I always tell people I I'm sorry I'm not the best person to ask yeah I know you're you're deeper in the lip most of the time yeah yeah no I I I haven't I honestly haven't taken that many courses but I follow a lot of clinicians that I respect a lot and whose work I've read as well you know so for so my soft tissue training mainly consists of just you know reading so I I started with um Herzler and Zur's book you know everyone like the Pink Bible um it really is great it is an amazing book it's 2012 ish 2013 um I think and then now they have a new book um a new volume out uh I haven't gotten it yet but um yeah I started with that pink bible and then um I got into Zuccheli now he has two volumes there's his first volume is just you know mucogenital surgery around just normal teeth um and uh his second uh one which is more recent came out in like 2020 ish uh specifically talks about mucogenital surgery around implants and so um I would look into that one um as far as uh oh I did take one online course that was like helped me kind of tie together all these things it's more granular um and it's more practical um and I do think that obviously it's hard to teach I understand how hard it is to just have everything packed into one course right but it's in in terms of just technique wise like uh I have moose that has an online course for soft tissue um that's is pretty good um now for in-person courses man we have so many options um you know a lot of clinicians I just follow their work uh like Schnezer Paul um Turek DeWan um just to name a few man there's so many I'm sorry my friends no no that's well I'm apologizing to my friends on on Instagram that I follow them and if I don't mention their course I'm sorry but there's just too many of you like yeah yeah uh there's just so many uh Perio Amigos you know they have one in the US that's great um but yeah there there's a lot you know and and people are sharing um um a lot of their course and if you see their working like yeah I like the way they think or even hey I like the way they present their posts you can kind of kind of see how what kind of educated they are based on how they put together posts or whatnot um like you you can kind of figure those things out but though I would start kind of looking there.

SPEAKER_02:

Okay. Yeah that's fantastic.

SPEAKER_00:

So you know we we've spent a lot of time covering you know fundamentals for people that are naive to soft hard tissue grafting I'm curious you know with where you're at all the time that you spent you know working on your own cases learning about new techniques what are the things that are exciting you what are you looking to get into I know you mentioned choreographing things like what are some of the techniques that you're looking to implement soon um to help expand your clinical suite um yeah I mean as as you as you know now I'm like knee deep in like um getting my startup going uh in about a month here so it's been weird because it's um and again it's just diving back into like leadership books and stuff like that and just also yeah how to run a business like dang like that's a huge growth for me and that's something actually will be probably a big focus of me this year is is learning the business side of things um and dealing with that. But I still want to sneak in some clinical stuff, you know, because um it's it's my love. But um zygos or you know zygmatic implant therapy is something that I'm um I'm really looking to get into um and not because you know sexy on Instagram or not I just truly believe like no this it's just the next step of progression for me and a service that I can provide at a very high level to my patients. Especially with the amount of doctors getting the full arch that maybe you know aren't getting as much training as they think they need. Like we just talked about a lot of the factors that you need to be a successful in this space and it's not just the clinical right um and and what can happen is maybe some less than ideal outcomes in what those patients need and we're already seeing in our in in my clinic I'm pretty um in comparison to a lot of the surgeons we follow like we're we're pretty new to this and we're already doing revisions you know um and so man just being able to be that source for my patients or or my community that can help do those revisions um at a more democra you know more democra democratized cost like it's it's it's something I'm very passionate about. Yeah. So um that's the reason mainly I want to learn that technique and uh be able to explain the the clinical toolbox there.

SPEAKER_02:

Yeah yeah I mean I think that's great. I think that you know I I I'm on my zygo journey as well and you know I missed a handful here and there. But you know I don't know that there goes my light again I we're at a race. But um you know I I think that with zygos it's like I I just need to be ready for when that time comes even though I've spent so much time never needing them because I like I I don't even remember the last patient I've had to actually refer out for zygos. Yeah and and it's so often that you know I can make things work but you still want to have that not only for the patient that has already had revisions um it can be for your own patient. Like we do a lot of marginal cases. I know you know one of my favorite cases to do is like a single or or a double whatever but like really atrophic Maxilla and doing like palatal approach and pteragoids and everything and that's awesome you know the first time you do it but then if it if it comes back and and things didn't work out, you know, yeah we're at we're at that last resort now Miss Jones. Like this is all we got right so you know you got to be ready for when that time comes and I I think you're you know certainly there. And you know I think for you you know with all the things that you already have in your toolbox I mean it's it's uh something you could say very authentically is you know look we're out of options like this is the last resort and fortunately I know how to do that.

SPEAKER_00:

Um so I think that's a very logical step for you and um you know it's much more logical for you now than someone that's maybe like six months out of school and says oh I want to be like the people on Instagram and you know post zygos right so yeah um yeah I know I think to address that right like what you said like I I mean I track every single case like I I'm I've I hit 179 cases fixed in the last you know since I started out of those 179 fixed arches I referred out 10 patients for zygometic care that were true I could not treat them um maybe it was just too borderline where I just you know even trying to trans it was just too sketchy you know too too borderline um I just rather than be seen by a provider that can actually do that.

SPEAKER_02:

10 you know so to to all the people you know clinicians young you know middle of the career late career like it it's not yeah and then and that's that's excluding the cases that you presented but they didn't follow through with treatment right like you only referred 10 you actually did 179.

SPEAKER_00:

There's a whole lot more that you certain certainly could have done without Zygo so you never referred right exactly yeah yeah um yeah those are the out of the cases that I treated um and yeah like I I would just say like hey this at the end of the day like and and Dr. Pico said this in his lecture you're one case away from losing your license right and it's not like you should be scared but it's like listen there's just has to be like there's if you're gonna get into anything full arch psychos or whatever um you just have to really be in it for the right reasons. Obviously you and I but a lot of the listeners of the podcast are in this because they you know really love and are passionate about you know surgery and and providing this kind of care which is a great place to start you know um but you know sometimes there's other motivations that we have to just kind of assess those kind of motivations and see if they really are you know um you know good for the patient. Yeah.

SPEAKER_02:

Yeah I mean I definitely think that you know zygos should never be any type of a financial motivation. Like I think it's okay to say to some degree that you got into full arch because financially um it worked well I I don't think there's anything wrong with that. I think it's inauthentic to say that that wasn't somewhat of a motivator you know I think it's a little ridiculous. But if you think that you're going to get into zygos and make money off of it like get out of here. Like that's a terrible idea it's such a bad idea. And um you're doing because you want to help these people and you want to be able to do cases like this. You want to advance yourself as a surgeon I think those are all you know valid and and uh valorant things to do. But you know you have to remember like if you want to be practicing for a long time um you know you've got to be selective and you got to measure your risk really carefully um because that's so true. And and you know losing your license is just like your whole life changes right um so it's just not acceptable to take that kind of thing out especially not for the sake of money.

SPEAKER_00:

It's certainly not worth that it sounds silly but the flex right like it really is a factor that that people it is affecting people like in in in all industries right yeah it's not something to you know it's it's not something to be quote unquote flexing it's just not it's yeah it's I actually respect the surgeons who like how like again how what can't remember the last time you referred out for Zygo because you were able to treat them with other techniques right and that's actually one of the conundrums I I want to ask some other clinicians is like hey how did you get good at doing Zygo because I'm looking at even my training course and I need reps to get good right how can I how can I ethically source reps you know or or doing this the right way based on my past like I can't wait another 180 fixed arches to get 10 zygo reps you know what I mean like so so if that takes you know going to you know mission trips or or taking multiple live patient courses to get those you know increased reps or having someone come to the office and all that like I'm all for that you know but I what I will not do is increase my personal indication of doing them just because I need to do them you know yeah yeah no I I I totally agree with that and and I think that last bit that you mentioned there um bringing people in office in my mind is the answer.

SPEAKER_02:

So you know where I'm at um you know again like 99% of the cases come through if they just don't need zygos even if they've been told they need them I know they don't because I can do them and I can do some really marginal cases. So if I'm if I'm presenting a zygo if I'm saying like this is going to need zygos like this is a case where like there is no bone like there is no we don't have shit like there's no max it's gone right um and what and so consequently most of the zygos that I do are actually quads. Right. And so like I have I have uh a few of those scheduled next month and I'm flying uh you know Chris Barrett is the one that's gonna be coming out again um to help me out with cases right and like because I you know I'm not doing these every single day like I am doing everything else I need some of that guidance I need someone to be there um to help you know guide my hand so to speak it's not that I can't do them or don't know how to do them but like I I need someone that has been specializing in this right like you know Chris he's someone that you know he's he's doing full arch in Phoenix which is kind of a competitive market right and and what he does is he fixes cases. So he is doing zygos on a regular basis right and I there is one camp that'd say oh well you just send them over to Chris right like you know that's not that practical for people right it's already a huge financial investment. Some of these people have already invested a lot in their care already they're already getting revised they're not trying to go somewhere else in the country and and spend all that money to get it taken care of. Well I know that I can do this especially under someone else's tutelage and having someone there um to back me up and and that's kind of the context where I'm doing zygos and that's how I'm getting my reps is someone's coming in and help me out with these cases. And I think I think that's a good way to do it. And you know financially it makes a lot of sense if you're a business owner you can charge for these things. You charge more um to help pay for someone that's going to help um help you do this. Obviously you do your own homework right like I got my my desk is filling up with you know 3D printed biomodels and stuff and I'm practicing on them and doing everything I can. I see that always it's always there and uh and yeah you know that's that's kind of where Zygos fit in my practice is you know there's not a lot of people around me that do them. There's hardly any that I can really refer to um and and I know that I'm doing the work to to be able to do them well and I'm flying and help when you know it's a little more complicated. And and and for me that that's where it fits. And I I think you make just such a great point is like how do you get good at anything that you don't get to do a whole lot. And if you've done you know all the work and had all the discipline to treat arches and and keep people out of zygos it can be I mean you kind of like competed your own self out of getting that kind of practice. But uh but yeah I mean I I I there is hope for me that you know as these patients come through the door and I and I treat a handful of fees I'll get a little more comfortable with the you know I I I would love to just do a unizygo. I would love to just do a case where I just place one and and then like that's it. But that that's not really happening for me because like I can I have so many other things that I can do. So if I'm doing a zygo it's it's usually all four but uh um but yeah that that's kind of where it's at I mean ask me again you know if if I want to keep doing zygos in a few months and and you know we'll we'll see how that went. But uh but yeah I mean I I think something that's really important to come away from it though is that you don't have to do that at all. Nope and you and your license will be a whole lot more secure if you never do and it will never make an economical difference. So like if you are doing this realize that you're a little bit crazy and and you're doing it you know it's a doctor thing. Like you're doing this as a doctor thing. That's it. It's not going to financially benefit you at all. And if that's okay with you if you're okay with taking that risk then go for it.

SPEAKER_00:

Yeah um but uh it's it's not something to be taken lightly um yeah but yeah so um all right we asked about you know what your um development looks like in the next you know year or so obviously starting a business shout out origin dental I think it's gonna be amazing can't wait to see how that's going in talking about the um you know implant world at large right what are some things some developments um coming out that you're excited about some new biomaterials some new treatment methodologies ai like what what's out there that's that's like uh you know rustling your jimmies um yeah I I mean I I think that's something that's a like a hot topic now is like subperiosteols right um mainly for the mandible because we have so many options for the the the Maxilla but also like for the Maxilla right once you you know how how do you revise a quad zygo I know some of the these guys out there as long as there's real estate you could possibly revise a zygo with a zygo but at a certain point you run out of real estate um you know I I I'm really excited to see um more and more research come out um especially getting my great mind Together, people that have done it a lot, like Dr. Picos and Dr. Jarek, um, people that have learned from you know the people that started these, you know, um Lenny Linkao and all these guys that um um that they trained with uh and taking all their experience and knowledge and and and pouring it into the development, you know. And I I hope that the um because we see it just even in in the normal dental implant industry, right? Like a lot of this stuff is uh is is product driven. Um so what I hate to see is um a product-driven treatment modality, right? It needs in the the treatmentality, the product needs to fit the treatment modality, not the other way around. Um and and so we talked about a lot of those different things, you know, the in in those lectures, which like really opened my eyes um into into how these things are being designed and whatnot. Just because a company's making them, just because it's FDA approved, does not mean that it's maybe the best design, you know. Um we see that in normal implants too, so or conventional uh implants. So I'm really excited to see more and more developments on that. Um I really hope that uh that companies can listen to experts that in our field um that are studying this, um, like Dr. Pigas and Jericho and and um and I'm sure more and uh Dr. Means some you know just listen to them and and and try to come together for to come together with uh something that works, you know, for the patient and not just oh what can I put out so my company can sell it? Um that's what I'm excited about. Um if you have any thoughts on that.

SPEAKER_02:

Yeah, no, I I feel exactly the same. I think that my zeal for um maxillary subperiosteols has definitely been put to bed um for the time being. You know, uh Dr. Picos and and Dr. Jirak, um, who's been on the show, um, you know, they talked extensively about that, not just in our episode, but um, you know, on stage and and and some of the issues that come along with that. And like you said, like there's just other things that we can do. Um, it's very rare that you come across a patient that couldn't possibly be treated with zygos and is really gonna need that maxillary subperiocle. And you know, those come with uh so many issues, they're so difficult to design. You have much more complex contours. Um, and uh, you know, that's that's just a realm where none of us really need to go. There might be a handful of people that are going to be treating um maxilla with things like that. But you know, when you come across like uh, you know, full arch mandible where you you everything's hourglass and and even like the you know, you you got nerves coming out of the crest of the bone. I mean, like regenerative dentistry, it can do a lot, but it it's not, I mean, it's not predictable at that scale to like really like rebuild a jaw. I mean, you might as well go get a uh a tibia, you know. Um I mean that that's really what you're looking at, is it like a jaw on a day at that point, right? So um, you know, I think it's it's it's a really beautiful, and I and I think it is a predictable treatment modality um for those really atrophic or um you know non-ideal contoured uh mandibles. And you know, I think Jirek has something like 130 cases under his belt. Ramsey Amin talked about it. He's got a good 80, 90, I think. And they talk about some of those complications, and and yeah, those don't look super fun, um, but I think they are manageable. And I think that if you're working with the right team, which I mean, pretty much you you should be calling Dr. Jirek if you want to do one of these things. I mean, you know, really I I think that's pretty much the only way to do this really truly correctly at this point. Um, I think he I think America's dental lab is who he uses, I'm pretty sure. Um, and uh, you know, go for that. And I think that's really cool. And you know, have somebody come out to help you out with that. I think that would be a really, really cool thing to do. And that's you know, you're doing something for a patient that I mean, there's a handful of people in the country that will do this for them. And that's really cool. And and it seems to have, you know, a signature of approval from people that have been doing this for um much longer than either of us have been alive combined. So um, so yeah, I I think that's a really cool thing to get involved in. Um, you know, it's it's maybe when I have the capacity for it, you know, I'll I'll get into it. So uh I think before my career's over, I'm gonna have some subs under my under my belt. I think they're just so rewarding, they're so cool.

SPEAKER_00:

That's for sure. I mean, uh, you better be calling me if you get a case so we can scrub in again. Oh, you're coming. But no, I mean I mean this is a great episode. If you guys haven't listened to the episode of Dr. Jerick, like I really suggest going back to listening to it. But like we got to see his presentation, and like, man, what I got out of listening to this uh on both you know things was just man, like going back to the topic of just doctor, you know, it is the product driven like for the patient's best interest, or is it driven because of the marketing or maybe the ease of the dentist? You know, yeah. Some and some of these things are are not patient driven, right? Like like Dr. Jerk was talking about, like, why are we why are we why why does it have to be fixed? You know, why they're already at this point. Your your other option is getting a jaw in a day with you know folks like Dr. Fayette Williams. Like if you can avoid that surgery, that's freaking awesome already. You know, like who cares if the denture comes out, you know, and it's it's better than a it's not a locator over denture, mind you, it's a it's uh it's a bar over denture. Um, and and some of these patients, it's really it's it's nice, you know. And if it avoids getting jaw in day surgery, then that that's that's that's probably something that the patient is is all uh again, it's all in how we explain it to our patients, you know, in perspective. Um, yeah, it's not gonna be as easy to restore as scanning some old, you know, popping, popping some photogametry flags on and scanning and sending it to the lab. And yeah, for the doctor, it's not easier, but like, are we doing this for the doctor? Are we doing this for the patient?

SPEAKER_01:

Right.

SPEAKER_00:

I mean, right? So um just just a lot like they were very eye-opening lectures and and um um in that podcast was really great. I really I think people more people need to listen to that. Um, yeah, and change perspective.

SPEAKER_02:

Yeah, yeah, I totally agree. I mean, there's a lot of uh buzz going around about um subs, but I I I think that you know deferring to the people that have you know really had to follow up on these for you know decades is is probably the most prudent you know thing to do. So um, but yeah, yeah. So Sean, I mean, this has been um an amazing sit down. I think we're we're we're kind of wading into the world of um uh mini-series at this point. I don't I don't think we're talking part one, part two. I think this is pretty much the Sean Lann um miniseries, and and I think that it's something that, you know, over time we could break out into, you know, and really go deep in a lot of these subjects. I know that, you know, as far as you know, where your knowledge is on soft and hard tissue grafting and all these different things that we can do, we really only scratch the surface of what's out there, and I appreciate you kind of dumbing it down for people like me. Um, but uh but yeah, I think we'll be able to dive deep on more topics, do some literature reviews, stuff like that. I think that would be really fantastic, and the audience would benefit a lot from it. But even if you're never on again, um, this has been a really awesome episode. I appreciate you doing all the homework, guys. This this outline that that we put together, I always put together an outline, this is the longest one I've ever seen. Um, this is like five full pages, font size 11. Um, you know, and we didn't even talk about everything. But uh, but no, thank you again for coming on. Um, you know, I I wish you luck and and all of your dental endeavors and and and thank you so much for coming on the show to share your knowledge.

SPEAKER_00:

No, 100%. It is so much fun, and thank you for having me. And man, it was just uh it's just great to talk to us here, the old friend, you know.

SPEAKER_02:

For sure, man. No, you bet. And and and also for anyone looking to um, you know, reach out to you personally, ask you questions, send you some cases. I know you'll love that kind of thing. Yeah, uh, where can they find you?

SPEAKER_00:

Um, so uh mainly on Instagram. I'm starting, uh I have to do the TikTok, I guess, for for the office. Uh, but mainly just find me on Instagram. We'll we'll we'll include it in the uh in the show notes. That's the main place you can find me. Um, and then and yeah, just reach out through me there and um yeah. Yeah, we'll put the uh the link to that, the uh the uh article.

SPEAKER_02:

Yeah, yeah, I've got that in our in our show notes here. And uh just as a as a word of caution to anyone that's looking for um Sean Land on Instagram, um, he has got to be the most imitated person that I have ever seen. Uh he I I know he has more dupes than Kylie Jenner. I have never seen Sean Land's on social media, so so just be aware of that. So is it is it at Dr. Sean Land S E A N L A N? Is that what we're looking for, or is that going to be another person?

SPEAKER_00:

Yes, and I wish it was, yeah, it's at D R S E A N L A N, and is in November. And for all the people that are out there looking, yeah, just dental and non-dental. That is my only Instagram account. It's verified for a reason.

SPEAKER_01:

It's got a blue chat.

SPEAKER_00:

I had to submit ID and all that for that. Um, it's my only account. I will never message you on another account, I'll never ask you for money. It's actually crazy. People have made more money off my likeness than I've ever made off the likeness. And yeah, I wish I wish I was being imitated for better reasons, you know. Like people imitate me and read more literature, sick. I would love that, you know.

SPEAKER_02:

No chance, no chance. They're scamming. Oh man, they're scamming big time with your with your likeness. But um, we're we're digressing here. But again, Sean, thank you so much for being on. Um, anybody that has any questions or wants to send some cases, seriously do reach out to Sean. He's extremely helpful, he'll give you a very well thought out response. Give him a little bit of time as he is in the process of a startup, and the next six months are going to be really fun for him. Um, but uh let him be a resource for you. He's been a huge resource for me, not only as a as a colleague, but as a very close friend. So again, thank you, Sean.

SPEAKER_00:

Thanks for having me.