Very Clinical: Composite Rehabs that Don't Suck with Dr. Colin Lathrop

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[00:01:26] workflow. This is a production of the very dental podcast network.

[00:01:45] Welcome to the very clinical podcast. In about the time it takes to do an MO on three,

[00:01:51] we will entertain an amazing with tips and tricks on regular daily dentistry. Here's Kevin and Zach.

[00:01:58] Buoyakasha clinical hacks nation and welcome to another episode of the clinical hacks. With me,

[00:02:05] I have this week my best buddy in dentistry Carolina Mac Jones. What's up Mac?

[00:02:11] Zach, what is up buddy? And what was all that at the beginning there?

[00:02:15] Have you ever seen the Dolly G show from MTV from I don't know 2004,

[00:02:21] three or so in that range? I know it but I've never actually seen it.

[00:02:24] I just watched the episode of their day and I wanted to bring in the show like that.

[00:02:27] I was feeling it. As promised we brought back my main man Colin Lathor.

[00:02:33] What's up Colin? Hey, hey,

[00:02:35] Mac and I were talking before the show. We're all enjoying a nice adult beverage this evening

[00:02:40] and we recommend that if as long as you're not driving while listening to this podcast that you

[00:02:45] get one too pull up this podcast pairs well with bourbon and a low cut pair scrubs unless you're in

[00:02:52] Louisiana and then just stop in and get a drop through Dacquery. There you go. That's the thing

[00:02:57] there. Yes, we're just slurricating. Yes, Mac. What are you what are you sipping on over there? It looks

[00:03:02] it looks too fancy for me but tell me about it. It's not too fancy but I have a little blanzen old

[00:03:06] fashion in the glass here. Treat me well. Excellent. Colin, what's what pairs pairs well with

[00:03:13] talking about big case dentistry to you over there? Well, you know I'm close to Mexico so I'm a big

[00:03:19] fan of Corona. With or without a line? Oh with. Let's go get the flies out. There you go. Booker's

[00:03:26] bourbon over here to pair with this exciting topic and as we are in the process of recording this

[00:03:33] Collins Houston Astros are in the playoffs. This will be released in a couple weeks. How far did

[00:03:39] the Astros get? We finished up game we won game two. We lost game one against those New York Yankees.

[00:03:46] So that's as far as we are currently. Yes, but where are we going to go? What's what's the end

[00:03:50] game for the Astros? Is this I think you know are they going to get this the second world series?

[00:03:54] You know, I think it's going to be the Astros and the Nationals and the series. Yep.

[00:03:58] That's what I'm banking on. You're banking. Are you going to go to any of the world series games?

[00:04:02] Yeah, if I can. Excellent. I've never been so I've always wanted to go. We'll take my son.

[00:04:07] Yeah, you see didn't get any of this 2017 World Series games, huh? Not the series games. I went to

[00:04:12] the playoffs and stuff with Yankees then, but yeah, I didn't make it to the series.

[00:04:17] I got very lucky that my 2015 Royals knocked out your Astros in a hard fought division series and

[00:04:24] I got to attend a World Series game that year. It was very highly recommended. Good experience.

[00:04:31] Some of the bucket list. It should be. It should be. Okay, so last week and if you have

[00:04:36] did not listen to last week, stop right now and go back because Colin dropped some awesome

[00:04:42] knowledge on how to get into big case dentistry if you're sick of filling class ones in class

[00:04:48] twos and doing single crowns. So if you want to get into the bigger stuff, Colin had a great

[00:04:54] tutorial last week. This week we are going to break it down a little bit further. Now first of all,

[00:05:00] if you have not seen any of Colin's posts in the clinical hacks Facebook group, stop. Go check

[00:05:07] him out because it will be a nice visual aid to what we're talking about today. So Colin,

[00:05:13] you have been posting some pretty cool kind of next level stuff on doing composite rehabilitation

[00:05:22] rather than full porcelain rehabilitation. And I want to know and Mac really wants to know

[00:05:30] died. Where did that come from? When do you use that treatment option? How do I get started

[00:05:38] offering that? Who do I offer it to? When I was in dental school, I would just sit on

[00:05:43] dental town and look at cases all day while the professors were reading slides to me.

[00:05:48] Nerd alert. Yeah, because it's bored. And I would see some of these composite cases where

[00:05:52] these guys would do all this crazy composites build up all these teeth and it seemed like it would

[00:05:56] take them like nine days to do it. So I thought I'm out on that. That's that that would take you

[00:06:02] long. When I started doing full art stuff and I always wanted to get approval for the temps

[00:06:11] your mockup or that sort of stuff get approval for the anatomy, the display, the length and all that

[00:06:16] kind of stuff before you ground on an animal. It seems like a really good idea to make sure before

[00:06:23] you you start doing irreversible things that people are paying a lot of money for.

[00:06:28] So as I did more and more mockups, I would still be looking at cases thinking man,

[00:06:33] I'd love to do this case to fix this two and a half three millimeters of wear on these patients

[00:06:40] that have really bright looking teeth and they're perfectly straight and they're just too short

[00:06:45] on some of these areas. They have a lot of functional wear. Man, I really hate to I really hate to

[00:06:51] grind and roast all that an animal just to put the nears and crowns and stuff like that on these

[00:06:55] really young 30, 40, 50 year old people. And I had some pushback from some patients as far

[00:07:03] as the cost goes to do ceramics. And you get to charge a lot because you got to grind a lot

[00:07:09] and then you have a lab bill and you get to compensate for future breakage if possible or whatever.

[00:07:15] You know, so you're not losing money on cases long term. And I just kept thinking man,

[00:07:20] if I can just do some of the things differently, I see this guy, Doctery on dental town posting these

[00:07:26] huge fan of Doctery. Yeah, composite deals right? Yeah, so I thought man, I just,

[00:07:31] I don't have the I'm too ADD dental wise to sit there for like six hours doing that stuff on a patient.

[00:07:38] Digital, you know, I was doing in business line at this time and I was thinking about getting

[00:07:42] a trios at the time. And so I was thinking, you know, I've seen these videos of people doing

[00:07:48] clear PBS and then they fill it up with dual cure composite and then they see it and they cure

[00:07:54] the whole thing and then they come back and they clear all this three and a half millimeters of

[00:07:59] buckle and lingual of flash off and regrind all the anatomy. And then they cut class threes,

[00:08:05] big class twos and all the teeth to open the context back up and they put all these fillings back in

[00:08:09] and I thought man, that takes a lot of time too. Yeah, I've seen that too. That sounds like it

[00:08:13] looks like it sucks real bad. It looks awful. And I thought you know these people, they have passive

[00:08:17] erosion or wear or both probably sleep issues also. And I thought you know if I could make like a

[00:08:25] shell that would go on the outside of the teeth that was hard, which could floss or individual

[00:08:31] and I can do it relatively quickly and maintain most of the anatomy that I planned and keep all

[00:08:37] interproximal contacts and check. Man, I'd like to do it that way. So I was looking more at these

[00:08:42] different cases and stuff and I saw this video on on genial universal flowable. It was put out

[00:08:50] like seven or eight years ago in YouTube and it was an injection technique but you know they were

[00:08:55] doing tough long tape and all sorts of stuff and it was the full thing and they squirt one tooth

[00:09:00] and then have all this excess come out from the next door neighbor. So I developed a little

[00:09:05] different protocol and the genesis of it was in a conversation with one of my previous associates

[00:09:11] is in Rob's Boral. He's out in Victoria, Texas. And we were talking about the I was using a

[00:09:16] digital designer at this time in Europe for my full art stuff so that I could have him designed

[00:09:23] because there was no blue sky plan and Crattle Bridge module, all stuff like that. I think in

[00:09:27] this Corriglan you know pushed on that one got it for us nowadays but then I use this designer

[00:09:32] in this guy's he's amazing but he was designing all the teeth and I'd do a mockup

[00:09:38] and then I prep him for crowns and such. So I was trying to figure out how to do composite and

[00:09:45] injected without a lot of flash and without all this excess on the neighbor's hand to be able to

[00:09:51] shoot pretty much most of the teeth at once fill them all up, cure across the buckle and link roll,

[00:09:57] get everything set, peel the matrix off you know that sort of stuff cure everything really well,

[00:10:02] polish it and then do whatever's left over. So digital design is different than wax steps,

[00:10:11] digital design you can design the whole case you duplicate it you know just duplicate the file

[00:10:16] copy and paste and then you go in and you just select every other tooth and delete it. So you have

[00:10:21] the existing tooth and then the next door neighbor that's been waxed up digitally to full contour

[00:10:27] and anatomy and inclusion and run through preferably a digital articulator to get rid of most of your

[00:10:34] interference issues. And the reason that I wanted to do it that way was just making the

[00:10:40] transfers was easier and maintaining the anatomy of each of the teeth was easier and there's

[00:10:45] different ways managing contacts and blah blah blah but the reason that I wanted to do it was I didn't

[00:10:50] feel comfortable grinding down for full crowns people in the thirties and forties because I looked

[00:10:57] there are going to have 15, 20, 30 year is what the research says. Hopefully 10 maybe 15 for my

[00:11:03] stuff maybe 20 I don't know if we get better or better but you know I'm also human and people

[00:11:08] have teeth and bad condition for reason they didn't take care of them right or they're in a bad

[00:11:13] arrangement or whatever else so I thought you know this 38-year-old 42-year-old person

[00:11:18] and I'm gonna do a full archer full mouthed ceramics and their 60s are gonna have to redo it

[00:11:23] they may not be able to afford it and then they're breaking down and what are you gonna give them

[00:11:26] a partial you know replace a bunch of missing teeth broken teeth at that point time and then in

[00:11:31] their 90s again or their 80s or or whatever else all this has failing all over again so I had a

[00:11:36] conflict of like an ethical dilemma I guess really I thought you know if I could do it in a more

[00:11:42] conservative way that you could repair over time you add back to it you can always convert them

[00:11:48] to ceramic in the future that's what really led me to do it it sounds like you're using this in

[00:11:53] you know knowing like all dentistry everything fails with time using this as a way to kind of I

[00:12:00] kick the kick the ceramics maybe down the road 10 you know 10 12 15 years if possible or yeah or

[00:12:07] or just staging the case where people can afford it over four five six years do some teeth now

[00:12:12] some teeth play a type of thing sure but you still have to get to the final before you do

[00:12:17] permanent anything sure and these are in cases that you're increasing the video you're having

[00:12:22] open the bite which most people can tolerate some opening yep sleep apnea wear patients as a

[00:12:27] erosion all these other things people can tolerate or people that just have small teeth and then when

[00:12:32] they smile they just barely show any upper teeth at all and it's not from lip mobility or any

[00:12:38] of these other things yeah they just have little teeth or continually missing teeth I have a case

[00:12:43] a little girl she's 15 she's got some spaces left over ortho has gotten her as far as ortho can

[00:12:49] get her and I don't mean just some run of the mill orthodontist the orthodontist who's doing her case

[00:12:54] has been teaching at the orthodontic program at the University of Texas in Houston for 40 something

[00:13:00] years this guy has seen every single orthodontic case you can see and he's treated most of them

[00:13:06] so when he called me and he said I've taken her as far as I can take her I said yes sir

[00:13:12] I understand but she's still had spaces you know she got the centrist lined up the customers

[00:13:18] are lined up there's still spaces because the teeth are the wrong shape and size around the arch

[00:13:23] and I thought you know I can't I can't number one and she's missing a few teeth in the front

[00:13:27] on the lower and I thought you know I can't do ceramics on her and I don't want to have it a flipper

[00:13:32] while she's 15 in high school that'd be awful and she needs these teeth she has no she's no

[00:13:38] molars I believe I remember right wow so she's a shortened and large and I treat all of her family

[00:13:44] they all have the same genetic characteristic that they're all missing different teeth they're all

[00:13:48] they're all a difficult case everyone is completely different as well but um I thought you know

[00:13:53] for her she wants to smile she doesn't like the spaces they're really small all this other stuff

[00:13:58] so she is a great example for this technique as well so I'm going to give her a beautiful smile

[00:14:04] that she's going to love and be able to maintain it and take care of it and you can always take it

[00:14:09] off you wouldn't want to really polish or they can pause it off that would be a you know what

[00:14:13] but you could if you had to term you're having to think outside of the box to give people different

[00:14:18] options based on their current situations because that can always change their age any of those

[00:14:23] sorts of things now calling like in terms of you know affordability for people is a composite unit

[00:14:29] in your office half of a porcelain unit or two thirds or it's about a third one third okay so

[00:14:36] there's a significant cost component there now the other thing you mentioned was that this G

[00:14:42] annual universal composite and boy that keeps coming up of course if you listen to Ali Sergei's

[00:14:46] episode he used it and our little stalwart companion here Mac Jones has converted to using that

[00:14:52] product love that stuff I've become a big fan tell me about your experience with it you've only

[00:14:57] been added a couple of months with it's what's what do you see him what do you notice and tell us

[00:15:01] about that product yeah I mean it's just a great material I'm using mainland posterior right now

[00:15:06] it's almost like a stackable flow it's kind of hard to describe until you use it but it can be

[00:15:10] manipulated around looks great polishes great polishes really easily but I'm interested to hear

[00:15:16] more about using the full mouth rehab here so Mac you do any transitional bonding or any any bonding

[00:15:25] in general on on some of your younger patients for cosmetic purposes is that in your menu of

[00:15:32] options you have at your office I have made a value attempts in the past it's some things like this

[00:15:38] and always bites me what what happens what fails for I mean I'm okay with Mac hash tag no failures

[00:15:44] but in these cases obviously the person didn't respect the bite so what happened oh man got to

[00:15:50] respect the bite yeah that's important you know I do have a good friend whose father came in to see

[00:15:55] me as a patient a few years ago and I try to do some heroic rib on bridges for him and he just had

[00:16:00] a really destructive bite and it it failed and it fell quickly but it did open his eyes to do

[00:16:07] with some more comprehensive stuff and we've done a couple of implants for him since then and

[00:16:12] it was a good intro to to more comprehensive dentistry for him you know I've noticed that also

[00:16:17] I feel like when I've offered something that was affordable for the person but but at least maybe

[00:16:22] describe the limitations of it and maybe offered to you know applies some of the cost of it towards

[00:16:27] something future that was a that was a way to you know get them into the right thing that they

[00:16:34] weren't going to accept in the first place that certainly has been a technique that's been

[00:16:38] been successful for me in the past yeah and I mean what I found is when patients realize you really

[00:16:43] have your best interests at heart you know they're a lot more forgiving about this you know they

[00:16:48] know you're looking out for them yeah that's a good point so this flowable composite is seriously

[00:16:54] your entire restoration con was that correct that's it's the whole the entire the entire buildup

[00:17:00] is in this material well how long you've been doing this what are you finding in terms of the

[00:17:04] how it's holding up to people's bites and daily activities and whatnot so when when most people

[00:17:09] see you know when they're reading online or they hear it that it's a flowable they're thinking

[00:17:14] as some rules soupy thin flow well that you're you're filling in a void or you're you're building up

[00:17:20] something before you do a crown or something like that this stuff is like thick honey okay I mean

[00:17:27] it is the thickest stuff ever it's a highly filled flowable there's several on the market but

[00:17:34] it's hard as a rock it's like liquid porcelain it is it is and then when you have to go back in

[00:17:40] to cut that stuff holy hell I mean it is like prepping a e-max crown off wow you know so

[00:17:47] so it's tough stuff and I've gone through a few different iterations of the technique in the

[00:17:52] protocol in order to do this efficiently and easily you know there's a few specific pieces of equipment

[00:17:58] you really need to have to do it but most of us have something like this you know but when you're

[00:18:03] cutting it you're polishing it I mean the stuff I mean it polices up it uses zirconia paste

[00:18:10] to polish it same as if you used to get that high shine back on zirconia crowns

[00:18:14] I get that tip from Michael Brum zircon paste that stuff is grits is green paste use of Robinson bristle

[00:18:21] brush or it's up like that on there but anyway um I mean you really have to refine everything back

[00:18:27] and you'll go through quite a few coarse and medium discs before you cut the anatomy down

[00:18:33] and then start really refining things polishing and everything else and then all of a sudden when

[00:18:37] you start hitting it with that stuff or a buffing wheel or whatever else I mean that stuff really

[00:18:41] starts to shine and like Max said it is like liquid porcelain you know the limitation of doing this

[00:18:48] is you're not going to get a perfect colored blend around all the teeth and those are the things

[00:18:53] that I talked to patients about you're doing this more like a mono if this is mostly a mono

[00:18:57] shade technique is that is that accurate or mostly yeah now I can go back in on some patients

[00:19:03] and I will cut back the incisolage I'll make a stand and all like as a and I'll cut back and

[00:19:08] up with some more translucent or you know some different enamel shades or that sort of stuff

[00:19:13] to really characterize it towards not so blocky but the thing about it is you still have a tooth

[00:19:18] underneath it so you're going to have that color of the teeth come through that material because

[00:19:23] you're not designing the crowns you know the digital wax up you're not designing the thickness the

[00:19:28] additive thickness to be super huge so you are going to get a color shift but it's not going to be all

[00:19:35] like super one color monochromatic that's the thing about it like I did a casey today and she

[00:19:41] was missing number seven she can't afford an implant she came to me from Nevada she had braces on

[00:19:47] she had six month braces on so she googled six month braces something or another in this area where

[00:19:52] she moved to she found me so she came in to see if I would take over her case and I said well

[00:19:58] I'm just going to charge you the full right for a regular case and I'm going to change things

[00:20:02] and that sort of stuff I'm not going to do it for like a perforated amount or whatever else

[00:20:06] she's like okay so I took over okay I finished it and I talked to her about ceramics and also

[00:20:12] as an implant blah blah blah I ideal dentistry full large stuff full mouth stuff because she had

[00:20:17] problems in the bottom as well well she's like starting over and alive so she didn't have money for

[00:20:21] all that stuff she said well I'll straighten everything and then I'll do something to fill in

[00:20:26] the missing space until I can afford that other stuff and I said okay I understand so we finished

[00:20:31] her ortho and I made her flipper like every other dentist makes in the world who's missing an

[00:20:35] upper lateral right chair and I said Kim you're not going to like this at all like you're going to

[00:20:39] hate it I just want you to know she's like okay give it to her sure she hates it yep so and

[00:20:45] I told her I said you know there's an option that we could do if you'd like they gives you the

[00:20:49] right length shape all the sort of stuff I feel in that missing tooth it's not perfect it's not

[00:20:53] textbook it's not going to look like a Hollywood smile or any of that sort of stuff but you know what

[00:20:59] when you're talking to your clients and that sort of stuff from a regular social distance

[00:21:02] you're gonna have a nice pleasing smile and if that's okay with you if you're okay with

[00:21:08] these certain compromises then this would be a great thing for you and she's like okay well I'm

[00:21:12] really scared of the needle it's like oh well you know what best thing ever I don't have to use one

[00:21:19] she's like really so told her more about it she's like okay yeah told her how much you'd be

[00:21:26] okay you know what I think I can make that work I'm gonna need four or five months that's

[00:21:30] okay cool when you're ready you call me and you come in and I'm gonna take a digital scan and I'm

[00:21:34] gonna work up everything and then it'll take me two or three hours total to do your case she's

[00:21:39] like okay so she came in a couple weeks ago and I did all the upper teeth even with a pontic

[00:21:45] on number seven I filled it all in like a Maryland bridge but it's all direct because you're just

[00:21:49] squirt head stuff in there I even fixed and baseline the lower teeth quillabrid all the occlusion

[00:21:54] or adjust that really I use a text scan for these cases because one of the biggest things is when

[00:21:58] you do a full arch or a full mouth additive anything patients don't know what's supposed to feel right

[00:22:06] so throw the marking paper away it doesn't tell you much they can't tell you where their first

[00:22:11] point of contact is they can't tell you if they're hitting more on the left side or the right side

[00:22:16] when you're drastically altering the video in a short amount of time you can go through

[00:22:20] into a whole bunch of you know close the adjustments over a lump period time and that's fine

[00:22:24] or you can get to a real fast the text scan so I'm an efficiency nerd I like to cut out a whole

[00:22:28] bunch of wasted time and energy because that cost me money the longer it takes for things to be

[00:22:34] completed the more problems can occur so if the faster you can get to the finish and maintain it

[00:22:40] the safer your dentistry is going to be so when I had this this lady's case designed I even pre-made

[00:22:48] a bi-laminar splint for her to protect them afterwards that we delivered as soon as we were done

[00:22:54] because we made it off of the digital wax that are printed on a Sprint Ray Pro so anyway I did

[00:23:00] her upper teeth with a pontic individual teeth and I had her come back for about 45 minutes or an

[00:23:07] hour and most of the three hours that I spent doing it I could have done her case in like an hour

[00:23:12] 15 minutes maybe but most of it I was taking video of it I was photographing I was doing a whole

[00:23:18] bunch of other stuff I took it a video afterwards get her comments because Cory Glenn and I are

[00:23:23] going to be teaching people how to do this stuff coming up because you know I just posted these

[00:23:27] cases just kind of share with what I'm doing just show people some different things that are available

[00:23:32] and I've given lectures on some other stuff before and that sort of stuff but I just wanted to

[00:23:36] share it really and then Cory he reached out to me he's like hey man you know Blue Sky Plan has

[00:23:42] this Crown of Bridge module and we can design the teeth and that sort of stuff and this would be a

[00:23:46] great add-on for this technique so yeah we're going to start helping other people learn how to do it

[00:23:51] Hi and it's you know your your posts have been extremely well received in the

[00:23:56] clinical hacks group and so I haven't feeling there's a lot of people that are going to be

[00:24:00] interested to get more out of that type of course give us just a quick rundown what's the

[00:24:06] armamentarium I need to get started with something like what are some like you know I have to have

[00:24:11] it's to be able to even think about getting started you have to have an ability to design the teeth

[00:24:18] digitally okay now if you don't have a scanner that's okay you can have your lab scan models for

[00:24:26] you okay you can send them a bite and have them scan the upper arch the lower arch and at the video

[00:24:31] so I don't need a scanner necessarily you don't have to have a scanner okay you need drop

[00:24:35] box so you can drop box those files to a designer or you need to learn how to use blue sky plan and

[00:24:42] look at Corey Glenn's you know YouTube videos he'll teach you to do it okay so I don't even

[00:24:46] need to know how to design it myself there's people I could farm it out you can outsource it I

[00:24:50] outsource that I don't I don't have time to design it I'm sorry I mean I wish I was gifted as

[00:24:54] as Corey on doing those things I don't have the time I'm too busy so I don't have to scan I don't

[00:24:58] have to design keep going I'm liking what I'm here and keep going just tell me I don't need any

[00:25:02] skills and then I'll be I'll be good to go I mean you need some skills but I know you're Dennis

[00:25:08] you have you don't have to have a 3d printer okay it makes it nice if you have on an office you

[00:25:13] can get to completion quicker but you don't have to you can send them to 3d did you works or if

[00:25:20] your lab prints or whatever else especially they have a carbon printer they get your lab to print

[00:25:23] the models on a carbon they're super nice and smooth and hard and you can get the models in so then

[00:25:29] you've eliminated a lot of those things you do need a mini star or a drew format okay I have

[00:25:37] mini stars in my lab it's got to be a positive pressure unit can't be a suckdown positive pressure

[00:25:41] okay gotta be a positive pressure you need a positive pressure unit anyway throw those suck down

[00:25:46] $400 Patterson unit pieces of crap away they're not accurate at all so anyway a mini star when

[00:25:53] you scan the material it had programmed time for heat time it has a programmed pressure on there

[00:25:59] and amount of time for for everything in there so if you can't screw it up if you just follow

[00:26:04] the sequences so that way you're you're reproducible so anyway you need a mini star or a drew format

[00:26:09] other than that some clear PBS and some genial universal flow or another highly filled who makes

[00:26:17] the clear PBS X clear is like the best one that's GC product as well yes okay I'm not so

[00:26:23] backwarder right now wow okay now I have used Benco house a version clear bite registration

[00:26:32] okay and it has worked just fine now there's a little bit more detail finishing and trimming

[00:26:38] and that's for the stuff involved but if you couldn't get the other stuff which I couldn't

[00:26:42] like on Kim's case I couldn't get it I was out and I couldn't get anymore because it was on

[00:26:46] back I even texted Ali sir he was the game man could I buy some stuff from you he's like I'm out

[00:26:50] bro it's on backwards on November I was like yeah great so all right so you need a clear PBS

[00:26:56] you need this you need a mini star you know highly filled flowable G. Anials what you use but there's

[00:27:01] there's other other options one two with that flowable I notice used a sand bluster do you

[00:27:06] oh yeah is that an important P I personally have one but do you need a chair side sand blaster to

[00:27:11] get the sun yeah I think you do too yes you really do again for efficiency it's just get a

[00:27:16] better bond strength you clear all the crap off of the roll the pellicle and then everything else

[00:27:20] octagates are nice those are cheap those are very nice and cheap I salite is even better with an

[00:27:25] octagate or actually dry or whatever your little knockoff stuff is that works really well for

[00:27:30] efficiency and that sort of stuff you need a drill and you need some diamond burrs most dentists have

[00:27:35] those things yes they usually have those preferably something for like an anterior composite finishing

[00:27:42] burr block is nice or just whatever you normally use to finish composites you're gonna go through

[00:27:48] them so you need some backups I use electric hand piece you can do it with air driven you know

[00:27:54] there's really not not anything you have to have and it's nice if you have a scanner in a printer

[00:27:59] and all those stuff but you don't have to have it so it sounds like even Mac Jones could pull this

[00:28:04] even Mac could do it wow I think I can handle it well that's that's the real litmus test here

[00:28:09] and you know honestly if you didn't have a mini star or a Drupamat ask your lab if they have a

[00:28:14] bio star I've heard of that yeah because if they can if they can print the models for you

[00:28:19] you can tell them the material that you want to use in a bio star it's the lab version

[00:28:23] a mini star is the in office version it's the same machine it's just the bios are as bigger

[00:28:29] and it handles things better and those are from great legs ortho okay so you really don't

[00:28:33] need to have any specialized equipment to get going on these cases but if you want to do more of them

[00:28:38] and all the other things available if you have these pieces of technology then those are good

[00:28:44] acquisitions to have so Colin tell us a little bit more about the upcoming course how close we

[00:28:48] to get some dates on that we're working on either January or March maybe of 20 is what we're trying

[00:28:54] to shoot for it just depends on logistics and you know getting things together some some material

[00:28:59] sponsorships but otherwise I mean my stuff's pretty well ready to go get it together

[00:29:04] coreys is ready to go for the design cool it's just finalizing the um the actual date

[00:29:11] but uh we're going to be working on that here pretty soon to where we can do that and release that

[00:29:14] and I've already been contacted from as far away as Australia for people that want to come to the

[00:29:19] course as soon as we you know release it um just seeing the cases and I've got a few more cases

[00:29:24] that I need to post up here you know Zach you asked earlier about longevity and what you

[00:29:29] know how the cases are holding up and that sort of stuff I worked on one patient he was he was 34

[00:29:35] the time 35 and lots of wear and I did 10 over 10 for him yep and I dialed everything in with a

[00:29:43] text scan when I was finished I gave him retainers when I was finished and you know the funniest

[00:29:48] thing is he he chipped off the insides of the edge of number 11 because he bit on a fork he did not

[00:29:54] respect the bike oh god he did not respect the bike whatsoever but he did not he did not respect it

[00:29:59] wow so you know that could have happened to an animal you know it had to do with the material the

[00:30:04] the procedure or any kind of stuff and he told me he slept better all the federal kind of stuff his

[00:30:08] teeth looked better he smiles now he never he never really smiled before it was a grimmest grin

[00:30:13] and I added back material and it was maybe 15 months later when I bonded the edge and you know I had

[00:30:22] his his box all of his models and his transfers and I put in a box and gave it to him and I said Jason

[00:30:28] if you ever had a problem if you chip something or break some knock one off or anything like

[00:30:32] that at all grab your box bring it to me so he did brought me the models and the transfers

[00:30:38] knock my stuff nice and I made a single tooth little tiny just as scored to you know a clear

[00:30:43] bi-registration on there just to reproduce exactly what the digital design was popped it in and

[00:30:49] and he brought his retainers with him and he popped him right in it's like yeah feels great

[00:30:53] and policy it took me like five minutes to repair it that's a good service that's a good service

[00:31:00] and so it worked out really well and I have quite a few other cases that are in service for

[00:31:04] a couple of years now because the every other technique with digital design digit you know 3D printing

[00:31:08] all that kind of stuff no it hasn't been around forever because you know 3D printers in a dental

[00:31:14] office haven't been around just forever you know so there's been a technology gap that once that

[00:31:21] you know I was able to overcome that when I started getting a 3D printing I was able to adapt

[00:31:25] that pretty quickly and apply those to these cases. Colin to me though I you know I don't think even

[00:31:30] though you're applying new technology this isn't a new thing. No it's not. Bonded teeth like just

[00:31:35] like you said with Doctery that's been around forever I've done a lot of composite bondages without

[00:31:40] all the fancy stuff that you're doing that's this lasted and held up yeah a really long time the

[00:31:45] most important things are well bonded bite constructed correctly night guards afterwards um

[00:31:52] and in a lot of patient that respects the bite. Absolutely and the cool thing about the new way of

[00:31:57] doing it is from the time that you come in for for a consult I can do a full arch or a full

[00:32:04] upper and lower and I stick to 10 over 10. If I'm adding the molars after that I will give them

[00:32:10] six months in the first 10 over 10 before I add back the molars before I activate especially on

[00:32:16] bruxers but anyway from the time that you come in for a consult the time that I'm done with you

[00:32:21] with retainers and all that sort of stuff that's three days.

[00:32:25] That's the real benefit of what you're talking about I think that is really cool and it takes me an

[00:32:29] hour hour and 15 minutes maybe per arch this is not when I'm not taking photos for lecture

[00:32:35] or teaching cases or whatever else I'm just taking just regular sequence of photos

[00:32:39] that sort of stuff it's hour and 15 minutes so it's about two hours two and a half hours for

[00:32:43] upper and lower 20 units and I charge about four grand for the upper units and about four grand

[00:32:49] for the lower units and I'm done and I've used one tube of composite and I've spent 220 bucks

[00:32:58] on my design fee and maybe 10 bucks or five bucks whatever it is it resin fee to print them

[00:33:04] a little bit of time to put them together and that sort of stuff so the profit margin is really

[00:33:08] nice the psychological margin is huge for the patient and then when I'm finished and I've

[00:33:13] dialed them all in I let them run for a month or so and then I'll check them again

[00:33:17] text scan all that then I'll scan them with the Iterra element and I'll have in Visla and make

[00:33:22] the Vera holding retainers to make sure the reason I do that is because I can scan them again in six

[00:33:27] months a year two years and I can use a time lapse function with an element to see how much are they

[00:33:32] wearing so I'm working on right now documenting the wear rates of these cases again this goes back

[00:33:39] to my research days and really nerding out and that sort of stuff but it's an application of

[00:33:43] technology we have available you know in Visla and they've already reached out to me to to

[00:33:49] lecture on some of these things for ortho and restorative combo cases and most people have

[00:33:56] oh yeah I do like 10 15 in Visla in case the year having Iterra it's great they have no idea

[00:34:01] the potential of what they have yeah because if you have one of those to do in Visla in your office

[00:34:06] that's how I started with these cases most of my early cases are all Iterra scans wasn't a trio

[00:34:11] for any other kind of stuff so so if you have in Visla in your office in a scanner I mean you're way

[00:34:18] ahead you know a lot of dentists would go to a case like this just kind of shoot from the hip and

[00:34:24] what's been even more time than you're doing this you're going in with an actual plan and getting

[00:34:28] this done much more efficiently I like it it is we're calling we are out of time thank you though for

[00:34:34] did you just had a you know 10 x over over 10 x on on these cases that's what you ought to call

[00:34:39] it with the efficiency that you've got to go on there so man I could talk to stuff for hours

[00:34:43] long as it'll run in a beer well we will we will definitely get you back especially as as maybe

[00:34:48] be sure course states lined up I definitely want to talk about that anesthesiology that you mentioned

[00:34:53] from last episode is as well here so thank you very much Colin it has been an absolute pleasure

[00:34:59] thank you guys yeah man so poor Colin and poor Mac Jones this is Zach Miners and stay classy