Fixed x Dr. Ryan Slone: The Comprehensive Approach: Balancing Prosthodontics and Surgery: Part 2

Full-arch implant dentistry can feel like two jobs at once: delivering precise clinical outcomes while also running a business that swings month to month. We talk through a deceptively simple question that affects everything downstream: should the patient be awake, lightly sedated, or deeply sedated when you’re doing big full-arch work? The answer isn’t about our preference, it’s about nerves, chair time, communication, and protecting occlusion so the final prosthetics start on the right foundation.

From there, we zoom out to ownership realities inside a fixed full-arch practice model. When volume dips, is it the economy, marketing performance, or new competitors undercutting price? We share how we think about “levers” without overcorrecting, why small sample sizes can make normal fluctuations look dramatic, and how we try to win on patient trust instead of joining a race to the bottom. A key idea shows up again and again: people choose the team that feels right, and that “match” often beats a $500 discount.

We also get practical for clinicians and students: prosthodontics in the 2020s increasingly rewards surgical competence. We break down what skills matter, how to evaluate residencies by talking to current and former residents, and why mentorship accelerates learning more than almost anything else. Finally, we dig into efficiency systems, assistant training, hygiene recall, and the prosthetic complications that actually show up over time, from access hole closure details to rare zirconia failures.

If you got value from this, subscribe to The FIXED Podcast, share it with a colleague, and leave a review so more implant dentists can find it. What part of full-arch care feels most unpredictable for you right now?

Transcript

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Welcome To The FIXED Podcast

Speaker 3 0:40

My name is Dr. Tyler Tolbert. And I'm Dr. Soren Poppe. And you're listening to The FIXED Podcast. Your source for all things implant dentistry.

Soren 0:49

intriguing for sure. Do you have a, um, a preference a-about the patient being sedated or not based on like, you know, obviously if a patient's fully sedated, you can't really check their bite appropriately until they're awake. Um, but, you know, is it, is it easier for you to do all the preps when they're sedated and then wake them up and then adjust occlusion? Or do you have a preference of, of just the patient being like maybe under oral conscious or just like a, um, just a local anesthetic?

Ryan 1:16

Yeah, I, I think I, if the patient is not nervous, I definitely prefer them to be some sort of awake. That might be oral conscious awake or that might be fully, you know, no, no sedation. If the patient is nervous,

Sedation Vs Awake Bite Checks

Ryan 1:28

I a thousand percent, you know, would like them to be in deep sedation with the CRNA just because, you know, um, spending that much time in a chair with a, a patient that is starting to feel mentally exhausted from the nerves, it's, it's not nice to them, right? It's not, it's not fun for me either because there's a lot of jumping. You know, they might-- they have to go to the bathroom a lot. There's a lot of like breaks and it just, it can drag things out. So, um, there's, there's not a hard and fast rule for me on that one. But if my patient's really chill and, and calm and not afraid, it's nice to have them awake because then I can work with them, like you said, bite here and open here and sco- you know, move your jaw over and things like that. Um, but I'll, I'll just try to do what's right for the patient that's gonna get them to where they wanna be

Soren 2:11

Absolutely. Well, let's, uh, let's transition a little bit into, um, into talking about, uh, Smile Now, and then I think we'll go into, um, some more Prost stuff. But, uh, I believe you, you're kind of at-- it's probably coming up close here to being almost a year in partnership, I believe. Um, what, uh, you know, how has the, the life at Smile Now been? Have you been enjoying it? Um, I know it's probably for anybody that worked in a GP-style office, and I know, or like a Prost office prior, uh, I'm sure you get to see the swings of full-arch. Like anybody that does full-arch c-can see, like, you know, you'll have a, an awesome month where you're like,

Partner Life At Smile Now

Soren 2:50

"Man, if we did this every single month, this would be the life." But then all of a sudden it's like a crappy month, and you have all this overhead from, from the, you know, everything going on in fixed and all the cases that you were restoring prior, and then it's like, "Oh man, that was, that was a tough month." Um, so I'm curious, kind of, you know, have you been enjoying, uh, working in, in the fixed style of practice? Um, how has it been with Smile Now? Um, you know, give us some of your pros and cons.

Ryan 3:18

Yeah. Um, I mean, overall it's, it's, it's great. It's been really good. Um, there's obviously challenges to, uh, understand, especially related to the flow of things. So I think I'll just maybe address like each little part of your question. Um, as far as working with Smile Now, you know, we're, we're actually lucky here because, um, we get to work with Steve. You know, he's, he's working out of our office, and he's, he's been great. You know, the, um, you know, s- the CEO of the Smile Now, the group. Um, and so being able to pick his brain about the business side of things has been excellent. Um, everybody I've worked with has been, uh, really helpful and just kind of bent over backwards, and it's, it's nice to, um, get to see all of that that's going on on the business side. Um, they certainly do a nice job there. Um, at the same time, I do feel like I've had, uh, you know, I've had a lot of e- people have lent me their ears, right? So when I have opinions on how things need to go, and, and as an owner, you know, I, I'd recommend X, Y, and Z. Um, Caleb's always willing to listen. Um, Steve's always willing to listen. So from a leadership perspective, from an administration perspective, um, I've had a lot of good conversations and, uh, convinced that I'm surrounded b-by some really good people. Um, from the perspective of, uh, running the business, I think that, you know, the most challenging thing with those swings is trying to understand if the swing-- what the swing is related to, right? So we're looking out, um, at the economy and, and we've got this war in Iran going on, and so we're, we're, you know, as these last couple months have been a little slower for us than the months prior to that, and you're thinking, "Okay, is it the economy?" Sometimes there's swings w-weekly, and so you're looking at marketing and you're trying to figure out, you know, is there any tweaks to marketing that we can do? Um, you're looking at your competitors around town. So there's, um, from the ownership side of the business, there's... It's just one

Marketing Swings And Competition Pressure

Ryan 5:08

big puzzle about how do we take the ups and the downs and try to even those out. And I-- and man, that's, it's tough to understand what's behind all that, so.

Soren 5:17

Oh,

Ryan 5:18

but it

Soren 5:18

you're telling us.

Tyler 5:19

If you figure it out, let us know. We could really use that information

Soren 5:24

You know, and it, it, and it's super challenging. I mean, I'm, I'm... I handle the marketing, right? So, uh, you're spot on. When, you know, when we get a dip, it's like, okay, well, how do we, how do we assess this dip? Is it, is it just, um, patients aren't clicking our, our ads? Is it, uh, are we not spending enough money? Um, and is it because of the economy, like you said? Uh, it get, it gets super, super challenging to make these decisions. And then the other, uh, uh, challenge that comes with marketing, right, is let's say you do increase budget, um, and, and the change doesn't happen. Well, then all of a sudden you're kind of stuck in this, in this cycle of paying more and more increased overhead for maybe a, a return that, that never comes. Um, uh, and then the other, the other factor of it is, you're right, there's more people coming into this space and competition becomes, um, kind of intense. Uh, you guys are, are in a challenging state because you're in a smaller market, so every single time a fixed office opens up, it's like, oh boy, now we have to, um... Instead of just getting a treatment plan from one office, now we're getting a treatment plan from three different offices, and a lot of these patients, it's just a race to the bottom. It's like, okay, well, you know, you know, you... I, I really appreciate the patients that come in and they're not as, um, swayed by a difference of treatment plan of a thou- a couple thousand bucks. Like, and they, they go to the place that they feel most comfortable with. But unfortunately, um, you know, that's not, I would say a majority of time that's not the case. And it's like whoever gives you a $500 cheaper, they're going to that, to that clinic. Um, luckily for you guys, I feel like in Boise, at least we haven't seen it yet, there isn't a, um, in the area that's like just super low balling patients and you guys probably get a little bit more of the patients who go to the clinic that they feel most comfortable. Um, and I would argue that we definitely win in that front in Boise. Like the Boise clinic between you and Dr. Stott, you guys do such a, such a good job. Um, a challenge I have in Denver is, you know, I do have people who are doing cases that are at incredibly low prices, uh, specifically so they can do volume. Um, and it becomes a, a, a difficult thing to, to combat because, um, you know, you know the care... The patients don't see what's under the, uh, what's under the, um, uh, whatever the, whatever that saying is, right? Like,

Ryan 8:06

Yeah

Soren 8:07

you... They don't see the implants, they don't see the placement, they don't see, uh, how the surgery was done. They don't see, um, you know, how it was planned. Um, and I mean, I would argue that Our clinic in Denver does some of the best work in Colorado when it comes to that. But, uh, it can be a challenge for sure to convey that to patients properly without, um, without making it look, you know, insulting to other providers that are doing this work. Um, so I'm glad to see it. It's, it, it's tough. From the business side of things, um, it's hard to know what levers to pull and when, but luckily I think that, um, you know, Tyler and I came from offices that were doing less than half the collections that we are. So we're obviously pulling some of the right levers, but, um, you know, it's always a daily challenge for sure to, to figure that out.

Ryan 9:01

Yeah, it's a...

Tyler 9:03

challenges is

Ryan 9:04

Go ahead

Tyler 9:04

the un- the unpredictability and whether or not you need to actually react to something that's going on. 'Cause, like, sometimes you can have, you know, months that are, that are slow just because they're slow, and there's not any change you actually have to make, and next month everything swings back around. And, you know, y- you don't wanna be pulling too many levers and changing too many dials all the time because there is some natural fluctuation that just happens i- in this market. We, we have low sample sizes. I mean, we, you know, a good... A, a fairly busy full arch office might be seeing, you know, 30 to 40, uh, new patients a month. You know, uh, that, that's nothing in, like, the, the general practice world. So it, it's just a different animal. And s- sorry I, I cut you off, Ryan.

Ryan 9:42

No, you're good. I, I was just saying, yeah, I don't, I don't know what the answer is either. I'm glad that brighter minds like yours, you know, brighter minds than mine like yours are on the case here, um, 'cause it's just, it's tough. I mean, I... There, there are certain things I believe in, right? Like I, I believe there's always room at the top, meaning not the top of the price range, but the top of, you know, quality. I, I, I believe that, and I, I would like to believe in the fact that the, the pie is big enough for everybody. You know, that, that the pie can get bigger instead of fighting over pieces of the pie. You know, and, and, uh, I also like to believe in, in what you said, Soren, where... And this is something I bring up with my patients, right? There's this concept in, in therapy, um, called therapist match, right? Where if you, uh, and granted, I don't... I'm not a therapist, maybe I'm saying this wrong. But if you are with your therapist and you feel like you have a, a match with them, like a, like you just vibe well or, or things, things feel right in your gut, then you get better outcomes in therapy, right? And I, I firmly believe like in dentistry, it's the same thing. And so that's, I think the competitive advantage that, you know, you and-- that you guys and, and we try to have in, in Boise is, you know, we try to be authentic and genuine and just try to match with people, you know. Because once they feel in their gut that they're gonna get a good outcome from us, then you're right. It's those 500 or $1,000 or, you know, whatever it may be, that, that starts to not mean as much as like, "Man, this just feels right." And so yeah, just, I don't know. I don't know what the answer is, but a lot, a lot of really important conversations to have there.

Soren 11:12

Yeah, I don't think there is a perfect answer, you know? It's just, um, combating all these things at once and continual improvement in different avenues will bring good results. Um, and you're right that there is, there is enough for everybody. Uh, I think the, the issue I have is when, um, people severely undercut that price to try to take a bigger piece of the pie and, and disrupt the whole flow of everything and create, create issues, uh, where, you know, volume isn't always the right answer. And a lot of times that can bring more issues to patients. It can bring, um, you know, more cases being done that maybe don't need to be done. Um, and then those patients are in a situation where then, you know, if that, if that office or that, you know, environment to close down, which we've seen. In Denver alone, I think there's been three fixed offices that have closed in the last year. Um, and those are for a variety of reasons, but then guess where those patients go? You know, they- they've spent X amount of dollars, a lot of them, all they've had, and then they have to come to offices like ours for us to fix those issues. Um, and I think that's, you know, the biggest hurdle that I deal with is trying to like, um, convey that to patients and let them know, you know, it's not always the, the cheapest an- the cheapest office isn't always the best option because, um, even if you get a lifetime warranty in a, in a $14,000 fixed arch, well, if that office closes because they're offering that treatment, well, you know, that lifetime warranty doesn't really mean a whole lot

Ryan 12:53

Yeah

Tyler 12:54

Yeah, very true. I, I think too, I really liked, um, what you said there, Ryan, about there's always room at the top, and I think that as long as you are to do this really well and conveying that value, you know, long-term, yeah, you're gonna have people that come in here and they're just like, "Yeah, I can do this at $12,000 an arch, and technically it's still profitable." Right? Like, they can do that for, like, a year or two with no repercussions, and they'll kill it. But then when you start going a few more years and some of those cases start coming back and they start having issues and they learn the real cost of fixed full-arch, a lot of times those, those fizzle out pretty quickly. They're not really long for the world. And the people that'll still be around are the people that invest in the education. They value their own work. They didn't undersell themselves. They got people like, you know, surgical prosthodontists and, and experts in the field that really know what they're doing well and know how to set up cases for the long term. Those are the ones that are gonna, you know, still be around in, in several more years. So I'm, I'm hopeful that, you know, the market, uh, you know, self-corrects in that regard, and I think that i- in our, you know, particular niche, we just don't have a very... I- it's a beautiful modality, um, but the insidious part about it is that it's not very responsive to bad work. Um, bad work can last, uh, for years without you ever knowing that you have bad work in your mouth. Um, and by the time you figured it out, um, you know, everything's been said and done for some, for some time. So I think it just takes a while, um, for things to shake out and for the wheat to separate from the chaff. But, you know, I think that, you know, as long as you're maintaining good values and principles and, and valuing yourself and what you do, um, you'll still be around, uh, for the long run.

Ryan 14:25

Yeah. I mean, I, I love that. You know, there's only so much in this life that we have control over, right? And w-we can control how we treat our patients, and we can control our effort level and... But can we control if the guy down the street's charging 10 grand for an arch? I mean, uh, you know, you can't. So I, I think that's a really philosophical way to look at it that you've kinda come up with there. You know, I, I, I appreciate that. 'Cause it is, uh, I think as dentists, we're prone to freak out a little bit, you know, with the ups and downs. So it's nice not to

Tyler 14:53

our industry is never gonna be as scarce as restaurants, right? Like, there, there are plenty of other industries that are so much more scarce, have so much more competition, you know, and, and they have price wars and all these kinds of things and, and we are massively insulated from that. So we just have to learn how to run a business. You know, I, I think that's one of the biggest challenges that we face. But just to kind of, you know, roll this back to, you know, more prosthodontic stuff. So, you know, Ryan, I, I think that you're, you know, very unique among, um, a lot of prosthodontists that I've, that I've met because you also have a surgical approach, and I'm curious, you know, from a philosophical point of view to other people who are maybe considering going into prosthodontics who, you know, may have gotten inspired to do so for similar reasons that you did. Um, do they need to kinda be preparing themselves to be surgically competent Is that kinda where, um, the market is moving itself, or do you think that, you know, you can still be a, a prosthodontist that, you know, just expects people to refer to them for, you know, FMR and doing crown and bridge and things? Or is the surgery thing just kind of a, a bonus? Like, what, what are

Why Prosthodontists Need Surgery Skills

Tyler 15:54

your thoughts on that?

Ryan 15:56

Yeah, I mean, I, I think you kinda hit the nail on the head. I don't, I don't know that, you know, in the 2020s that you can exist, um, v- super successfully as a prosthodontist only taking referrals and only doing restorative. Um, I, I think there will always be a market for that. But I, I think, you know, the question implies, you know, what can you do to be really successful, right? And, and success can be a lot of things, right? It's not just monetarily. It's, it's, you know, how do you see yourself in the mirror? It's, you know, how's your family life going? All that stuff. But, um, in terms of financial success, I, I think, you know, we're in a day and age where, yeah, if you're a prosthodontist and you're not doing surgery, uh, I think it, it's a little harder to refer to you, you know, from the-- as an outside source. And I think you're, you're limiting yourself in a big way in terms of your income stream, right? Because of, you know, sur-surgery does, um, allow you to have a, a separate stream of income from restorative. Um, so I don't... Yeah, I mean, if I was to give somebody advice, I would absolutely say pick a residency where you'll be able to learn good surgical skills. And that doesn't have to be all on X, right? That doesn't have to be... It can be whatever their comfort level is. But, uh, every prosthodontist should, should know how to place singles, should know how to do, you know, good, uh, alveolar pre-preservation after an extraction. Um, I, I believe as well should know how to do a good crown lengthening case, you know, for functional or aesthetic reasons. Um, and I think that just makes a lot of sense. I, I can't make it make sense to do otherwise, you know, based on what I've seen.

Tyler 17:24

I like that

Soren 17:25

Are you finding that prosth residencies are, are understanding that and transitioning into a more, um, I guess, rounded approach to teach their prosth more surgery and more crown lengthening and things like that?

Ryan 17:39

Absolutely. Yeah, I think, I think there, there are a few kind of holdovers of residencies that may not be doing that, but for the most part, um, the question is to what degree, and it's not whether they do it or not. So every residency is gonna prepare a prosthodontist surgically. It's just a question of, you know, who's doing what, to what degree. Is it immediate load or, you know, is there soft tissue grafting involved with that, that kind of thing. Um, and so as, as you know, if somebody's looking into a residency, that would be the, the questions I would ask is what-- One, what are you interested in? Because, you know, some prosthodontists get into it for more of the lab work side. A lot of prosthodontists will open their own lab, right? And, and that's... There are some residencies that do really well with that. Um, other prosthodontists, you know, like myself, wanted to get into the surgical while still maintaining the restorative. Um, there are some residencies that do really well with TMD and, and oral facial pain. So it's, it's just a matter of like under-- And then obviously a lot of prosthodontists get into it as well for, um, uh, the, an academic career track, um, because that will accelerate you faster than almost anything, right? So understanding what the end game is and then picking the right residency, um, for that. But I think, I think all residencies are surgical. I'm sorry?

Soren 18:50

Oh, no, no, no. If you, if you-- you know, there's probably students here listening to this, um, that are interested in fixed, but, you know, maybe want to do like a PROST residency. Do you have any-- I, I know you've been out of it for quite some time now, but, um, for somebody that wants to do what we do, fixed surgery, but also wants a good understanding of PROST behind them, do you know of any residencies that maybe lean a little heavier on the surgical side? Or do

Ryan 19:16

Yeah, I think

Soren 19:17

for someone who's done res- or who's looking into residencies to figure that out?

Ryan 19:22

Yeah, um, I'm, I'm a few years removed. Uh, you know, the, the one that's kind of famous is, uh, uh, Bedra up at Connecticut. He's kind of the, um, maybe at, you know, at the vanguard of that kind of, of surgical prosthodontics. Um, my residency in-- at the University of Tennessee had a, a pretty significant surgical component, uh, to it. But like I said, I'm a few years removed. Uh, so the most important thing that a student could do is, um, just go shadow and, and talk to the residents, right?

How To Choose The Right Residency

Ryan 19:49

Uh, shadow the current residents, talk to them, uh, talk to everybody, but also call some of the graduated residents, you know, the ones that are one to two years out, and say, "Hey, did this residency prepare you for what you wanted to do?" And, and see if, you know, make sure they're aligned with what you wanna do, right? And then ask them. And so that's kind of what I did as well. I w- I called up some previous residents. You know, one of, one of kind of the, you know, quote-unquote "dentally famous," um, residents from the University of Tennessee, um, is, is Nick Egbert. You know, he lectures a lot for Southern. Um, he, he lectures with Picos and things like that. And so I actually just called him up and I said, "Hey, this is what I'm interested in, you know, what do you recommend?" And, and so, yeah, I, I think whatever, whatever you wanna get out of a residency, um, just do a little, a little due diligence to find out if the residency claims to be doing that and if the residents that have graduated, um, would-- can verify that they got what they wanted out of it.

Soren 20:45

No, I think it's a great answer. I mean, uh, we get at-- we, and, we've had past podcasts where I've had a very similar answer to, um, you know, how do you get into, to full arch quickly, and not even through the prof side, but I, I feel like my answer always has been, um, the only way that you can like let in professors and people know that you're interested in this is to go there, you know, let them know like, "Hey, I want to do more surgery. Like, this is what I'm looking for. Um, please give me as many cases as you can. I, I am more than happy to put whatever time I need to, to get that done." And that's, that's how I got my surgical experience, was just putting my foot in the door, letting them, them know like, "Hey, um, I'm happy to, to stay late. I'm happy to come in whenever to get these cases in. I just wanna get as much experience as I possibly can while I'm in a academic setting." Because, um, as we all know, once you get out into the real world, it gets much, much more difficult to get that experience. Um, you have to like go in headfirst into clinics, um, and, and outside of specialties, like as, as general dentists, that kind of thing is, is even harder. You, you have to go to an office like Affordable or, um, an office that's really heavy on surgery. And the difficult part is once you get into private practice clinics, um, a lot of these providers, uh, they want the cases from the-- for themselves. You know? They like if they're doing a fixed office, they wanna do the cases and it's hard to bring someone in and train them and, and do all these things. So getting that while you're doing, um, your academic portion of, of dentistry makes it so much easier to, to learn and get these cases under your belt.

Ryan 22:28

Yeah, I mean, I, I think you hit the nail on the head. That if, you know, if you can find a mentor, whether in school or out of school, um, that is just invaluable. I mean, that's what residency is, right? Is just a mentorship. Um, but also I, I think if I was giving advice to dental students r- regarding what you said, 'cause I, I've heard your story, right? Is that I, I think a lot of dental students will go, uh, to faculty and say some of the same things. But, um, that I think you kinda proved yourselves, you know, both of you by... I know you were reading extra textbooks, you were, you were studying, you were doing all the extra stuff. And once I think a faculty member or mentor sees that you're willing to go put in the, the legwork and it's not just, it's not just lip service, I think that's when the, the doors open up like, like yours did, right? 'Cause you were willing to put in all that extra work. So I, I mean, I think that's great advice

Soren 23:19

Yeah. Um, well, so let's talk about, uh, you know, what, what kind of does, does your future look like to you? And, and what I mean by that is, is clinically, professionally, like, um, in the next couple years, is there anything that you wanna do that you haven't done clinically? Um, is there any CE that you're looking to take that you haven't? Um, you know, and then, and then I'd also love to hear, uh, are you happy with kinda the route you've taken? Is there any changes you would've made going back and looking at dentistry?

Ryan 23:49

Yeah. I mean, ooh, that's a, that's a lot of loaded questions. I like it. Um, so in terms of like professionally, what are my... What's that?

Tyler 24:00

I said feel free to break it up a little bit too. That was a

Ryan 24:02

all right.

Soren 24:03

Sorry.

FP1 Goals, 3D Printing, Efficiency

Ryan 24:04

No, that-

Soren 24:05

I meant, you know, what are you looking for in the future, and then what, what, uh, changes would you have made in the past?

Ryan 24:10

Yeah, absolutely. Well, um, so in the future, I, I think that one of the great things about All-On-X is that it's-- there's an, an endless road of, you know, uh, accomplishments or of, of levels, right? There's levels to everything. Um, and so I do wanna take... I wanna take a really good FP1 course. I'm looking at maybe Naif Sonata's course. Um, I wanna take, you know, I wanna continue to develop my FP1 skills, especially, you know, tissue sculpting and things like that, root banking. Um, you know, I, I think, uh, 3D printing is always especially wh-where that's headed. I'd like to, you know, look at some of the Wall Urinay stuff, um, for 3D printing. Um, I would like to, uh... I think efficiency is a really big thing for me, right? So whether it's All-On-X or FMR, I'd like to, um, look at how I can improve my efficiencies. Uh, and not just through like frantic speed, right? But through seeing if I can get-- reduce my time to complete an arch. You know, that's something that Caleb is really good at, and especially, uh, prepping as well, you know. Um, I would love to be able to get my time to prep a full arch down, um, while still doing a really nice job. So efficiencies are a big part of that. I'm also, um, pretty heavily invested and, and very interested in, uh, training my staff, you know, and, and this has been on my mind for the... You, you asked the question about, um, ownership and how the last year of ownership has been for me and, um, staff training is probably one of the number one things of how can we, how can we get our staff trained up to just an absolutely excellent level of, um, being detail-oriented and efficient? Um, because the more that my staff can do for me, um, in a way that I trust and can verify and know that they'll do a good job, the more efficient I am, the more patients I can treat, the better work I can do. You know, the more I have to do myself, the more

Training Assistants To Remove Dead Time

Ryan 25:56

things kind of bog down. And I'm not talking about things that must be done by dentists, but, um, certain things that a really well-trained dental assistant can do, I'm, I'm super interested in that. And so big picture, long term, I, I do see myself with some really core dental assistants who are trained, you know, as excellently as I can train them, who are super invested in doing things in a, a really high-quality way and seeing what that-- what doors that might open up for me in terms of how I can run the practice, right? How do, how does scheduling work? How does treating patients work when you have an army of people behind you that can do an excellent job? Um, so those are, those are kind of the things that are on my...

Soren 26:35

yet

Ryan 26:36

Go ahead.

Soren 26:39

Yeah, I was gonna say I love that. I mean, I know in my clinic I, I'm super blessed to have had the same assistants for a really long time. Um, and I get asked all the time, you know, about efficiencies because it's something that we preach a lot on the podcast is, you know, being able to, um, cut an arch quickly enough, and I shouldn't say quick, but efficient enough, uh, where you're, you're not, um, causing the patient grief, let's say if they're not under sedation or, um, sitting the patient way longer than they need to be for, for certain cases. Um, and a big, a big thing that I always say is, uh, training the assistants properly. So making sure that you only pick up an instrument once and the p- and the assistant knows what instrument you need before you even know. There's a lot of times where I'm doing surgery and my assistants are handing me the instrument, and I'm like, "Oh, yeah, that is, that is the next step. Thank you for, you for, for handing me that." Uh, and it just makes, it makes life easier, right? It makes, it makes doing the surgeries much nicer. Um, so I think, I think you hit the nail on the head there and, and I love that, that you're considering going to an FP1 course, and I think, you know, we've, we've... Have we had Naf on the podcast? I'm not sure if we have had him on the

Tyler 27:53

I've been trying.

Soren 27:54

he's a, he's a busy guy.

Tyler 27:56

I, I'm in his DMs shamelessly. I, I am

Soren 28:00

I, I've talked with him quite a bit in person, and great guy, and I think that would be

Tyler 28:03

No

Soren 28:03

an actu- an awesome course to go to.

Tyler 28:06

Yeah

Soren 28:07

been to Wally Renee's courses, and they are excellent as well. Um, I mean, except es- especially for, for doing FMR stuff like you're doing or, or veneer stuff.

Tyler 28:18

Yeah

Soren 28:18

was a little bit over my head, uh, some of that. But, but man, all, all excellent shout-outs there. I think, I think that, um, I would, I would totally agree with all those ones that you, that you mentioned.

Tyler 28:30

And I, I would say too, just to, just to ping off of the efficiency thing is, um, I think what, what people find when they come, and I'm certain I'm sure you've noticed this too, is like when they come to shadow me, um, and they're trying to figure out how we do things effic- as efficiently as we do, like say getting a double arch done in under two hours or an hour and a half, whatever, I think there's always this assumption that like we just move faster. Like we just do things really quick or our hands are fast or, or something like that. And yeah, maybe to some extent we're very deliberate and, you know, we can do things in a single pass and we don't have to keep going back and forth and, and that those things matter. But I think after a certain point, what really makes you efficient is, is how well you delegate things to your team and how well, uh, that communication goes to where it's not even having to be verbal. Like there's no... There-- You're not being slowed down 'cause you're having to actually physically like ask something. It's, it's, it's just known. Um, and you know, my assistants are always at least one step ahead of me, if not two. And oftentimes they're, they're telling me, you know, "Hey, you forgot this. You did that." You know, that's on me, right? There's, there's areas where I still slow things down. But if I'm, if I'm keeping up with them and if I'm keeping up with my steps and the, and you know, they're handing me the drill and, and I'm ready for that, that's when things get really fast. Um, and it's not a matter of just having faster hands or rushing through things. It's, it's really that system that's everything and that especially a two-assistant system, um, where you're doing surgeries and, and really getting that ironed out and just figuring out how many things can be going on at one time and, and making sure there's never any dead time where only one thing is happening. Um, but, uh, but yeah, on, on the, on the course front, uh, you didn't mention, uh, we actually have a course we're going to together in a, in a couple, two weeks... In a couple weeks. Um, you know, we recently had Dr. Tony Pilato on the show, and he does a show with Dr., uh, excuse me, he does a course with Dr. Sven Bone, who's also been on the show, and they're doing one out in, uh, Bozeman, Montana in a couple weeks. And so, uh, Ryan and I were going out to, uh, learn about the arch nemesis or the nemesis of full arch is, is prosthetic complications, right? And c- certainly there's so many of those. Um, and I, and I'm curious too, Ryan, as far as prosthetic complications come along, so on some of the follow-up, uh, that you've seen here at Boise, 'cause this is our longest standing clinic, you know, are there some issues that you've seen come about in sort of the long term on some of these finals with maybe screw loosening or breakages, um, things that you've seen

Preventing Long-Term Prosthetic Problems

Tyler 30:39

that, you know, maybe there was something missed, uh, in the process or there was something that could have been improved, some things that maybe you've implemented that maybe, uh, you know, mitigate those long-term prosthetic issues? Any, any revelations that have come up?

Ryan 30:52

Yeah. Man, you guys got some great questions. This is awesome. So, um, in terms of the long-term stuff, I-- we have seen, I think I've seen one case of screw loosening, you know. So that, that has not been an issue at all,

Tyler 31:05

Nice

Ryan 31:05

um, on, on finals, right? Occasionally get those on temps. Um, I think on, in terms of something really minor, you know, I, I think the, uh, the screw access hole closures as we follow those over time. You know, I, I would love to see, um, screw access hole closures that still look as fresh, you know, um, in two years as they did when we put them in. And sometimes we'll see, we'll see those depress a little bit, like if the Teflon underneath is not well packed, we'll see some of those fall out. And so I'm, I'm working with my team on just making sure we, we, um, cover the screw access holes, uh, in a really, really nice way and, and just trying to make sure we, we fine-tune that. And I know that's little, that's not kinda what you were getting at, but that is, that is the one thing that comes up is I'd like to perfect that. What's that?

Tyler 31:52

Oh, I was gonna say if that's, that's the worst we got, we're doing okay. Just saying we're... I, I was just saying if that's the worst that we've been s- that you've been seeing, then we must be doing pretty good. We must... No, really, that's great. I, I would love it if that was all I ever saw.

Ryan 32:01

Or, I mean, we have the standard, you know, um, people need to do better at cleaning underneath their prosthetics, you know, and, and that's more of a biological, yes, for prosthetic complications. That-that's more biological, and a lot of that just depends on the patient. Um, we've implemented a really nice hygiene program here with a just a rockstar hygienist, and she does such a good job of helping them, and it helps us to keep track of patients there. Um, and so that, that's been really good. You know, I, I've always had my eye as well, you know, when you're doing monolithic zirconia direct to, uh, direct to the mua without any ti base, there's always the theoretical concern that you're gonna have, um, kind of breakage of that coping, the, the zirconia coping. Um, so we, we, you know, out of the hundreds of cases we've done, I think I've seen three of those, um, chip, so nothing, nothing significant there. Um, so prosthetic complications, thankfully, you know, and, and then we do have the occasional breakage of a monolithic arch, right? So that's... I, I don't have a stat here, and this would be really nice to actually look into that, but, um, I, I, I... It would be... I'm sure it would be less than a percent. Um, but occasionally we will see a breakage, and usually we'll have the arch remade in case there's some sort of a, a defect in the zirconia. Um, and I can count, uh, maybe once or twice that we've had the same arch break twice, you know. And so then we go to titanium reinforced and that kind of thing. So, so I, I don't know that we've had, uh, a worrisome trend at all. I think, um, a lot of this is just a numbers game. If you, you know, if you're doing hundreds and hundreds of arches, I think some of these things will come up. Um, so nothing that I'm worried about yet, um, but tons of things that we can improve on, like I said, the little access hole closures. Um, yeah, making sure the patients have the, the teaching and the tools they need to be able to clean under them, making sure we don't lose patients to recall, you know, because a lot of patients, you know, just they miss one appointment and, and do we have the systems in place to make sure that we, um, you know, get them back on the hygiene recall schedule, things like that. So, um, as far as... Oh, go, go ahead. Sorry.

Tyler 34:03

No, no, no. Please keep going. I was just gonna bring us back to Soren's compound question about, you know, uh, things that you might change in the past as far as how your career's gone and how you might have changed it to, I don't know, maybe, maybe be further along or wha- or whatever that case may be. We always ask people about what they would change about their, about their journey

Ryan 34:21

Yeah. Um, gosh, that's a hard question for me. I don't know that I would change anything, um, just 'cause I- hypothetical like that are tough, you know? And I, I am who I am today because I've been through what I've been through. Um, and so I, I don't know that I would change anything, but I, I think there's a lot I can maybe glean from what I've gone through and, and I think the biggest thing is just, uh, mentorship, right? If, if

Mentorship Mindset And Reaching Out

Ryan 34:43

you've,

Soren 34:44

Mm-hmm.

Ryan 34:44

if you've got somebody around you that is, that is where you wanna be, that's doing what you wanna do, um, there's nothing... The, the, the learning that you can get from a mentor is accelerated like tenfold over what you get from a course, from a textbook, um, from even, you know, a residency even though residency is mentorship. Um, but that's, that's been the biggest thing is everywhere that I've worked, um, school and everything, there's been people where I'm like, "Dang, that guy's doing it the way I wanna do it," or, you know, I wanna learn, I wanna learn that skill from that person, and that has blessed me more than anything. So, um, I don't know that I have any do-overs, you know, 'cause I'm, I am who I am. But, um, I think that's been my big takeaway, just, just finding somebody to work with that can teach you what you need.

Soren 35:27

I think you'd be surprised too with the amount of clinicians that are happy to, to help, you know? I know for me, I've probably had, not as many people as I would have thought reach out to me and actually say, "Hey, you know, I wanna come to your clinic. I would love to learn from you." And every single one that has, I'm like, "Absolutely. Come

Ryan 35:48

Yeah

Soren 35:49

I, I'm, I'm happy to help you, and I'm happy for you to come, um, and watch what I do and, and see that." And like, um, I think there'd be-- there's so many dentists and, and dental students out there that, that have big dreams, and it- all it takes is just asking. Because a lot of these people that, um, you might look at as, as like an idol, um, they're probably more than happy just to, to have a conversation, jump on a phone call, do this and that to, to support you along, along your journey. Um, and that's me talking to people listening to this. Uh, and I hope that, um, you know, people really take that to heart and they do reach out to the people that they look up to, because, um, you can get so much further in your career so much quicker just by getting some nuggets of information from somebody who's been there and done that.

Ryan 36:38

Absolutely

Tyler 36:39

Awesome. Well, Ryan, um, you know, I, I really wanna thank you for, you know, coming on the show and, and sharing your story. And, and also thank you too just, you know, for being a partner here at Smile Now. You brought, uh, so much value, uh, to the fold and clearly so much, uh, knowledge and information. And, and I really can- I, I've read some of your dissertations on, you know, certain topics that Caleb's asked you about, uh, with mutually protected occlusion, all kinds of things, and, and they're brilliant. I, I love how verbose you are and, um, I'd love to see some of your lab scripts as well. Um, but, you know, jokes aside, uh, I really look forward to, uh, you know, going to the course with you. Uh, Arch Nemesis, I'm sure we're gonna, you know, do a download after that and, and talk about, you know, what that can bring, uh, to our model,

Course Plans And Closing Banter

Tyler 37:19

and, and we'll certainly review that, um, here on the show as well. And, um, and yeah, thank you so much for, for coming on here and, and just laying yourself bare and, and talking about, you know, everything, uh, leading up to this. And I just think you're a fantastic clinician, and, and I really appreciate you, you know, sharing your story with everyone, and I'm sure our audience values that too

Ryan 37:38

Well, yeah, thanks Tyler and Torin. You know, this is fun and, and, uh, it's-- You guys do a really nice job of, uh, you know, just creating a conversation, making it easy to talk and, and fun to share. So it's a, it's a good experience, so keep up the good work

Soren 37:51

I think you do need, uh, I'm pretty sure Tyler's done the full outfit, uh, haul for, for this trip. So make sure to, to chat with him about that and get some, get, get a nice belt buckle, maybe a cowboy hat for this trip.

Ryan 38:04

I know. I'm

Tyler 38:04

Yes. Yes, it is cowboy themed. I, I did text him about the boots. He, he should've been heading down to Boot Barn.

Ryan 38:10

Yeah, I

Tyler 38:10

Boot Barn by now

Ryan 38:12

I have not gotten the boots yet, so, but I, I talked to my wife about that the other day, and she was like, "Oh, that's funny. You'll probably never wear them again." I was like, "Well, maybe I should start wearing boots to work or something," you know?

Tyler 38:21

Who knows? Who knows? I also, I got some bootcut jeans as well that I'm very excited about,

Ryan 38:27

Yeah.

Tyler 38:28

I

Ryan 38:28

Hey, I'm gonna get,

Tyler 38:29

Einstein.

Ryan 38:30

I'm gonna get some pearl snap

Tyler 38:31

gotta, I gotta-

Ryan 38:32

the competition there

Tyler 38:35

Yeah, please. I think a bolo tie would really tie it all up, but

Soren 38:38

there we go

Tyler 38:39

we'll leave that one for you. You can bring that. So, um, but yeah, again, Ryan, thank you so much for coming on, man, and, and I'm, I'm sure that you won't be a stranger to the show. We'll probably have you back on, uh, again sometime, and, and we'll talk about, you know, the FP1 courses and all the other things that you've learned, uh, in, in the years to come. So we really appreciate it

Ryan 38:56

Thank you guys