Very Clinical: Dr. Tarun Agarwal Has Changed His Mind About Implants

[00:00:01] This is a production of the Very Dental Podcast Network.

[00:00:16] Welcome to the Very Clinical Podcast. In about the time it takes to do an MO on three, we will entertain and amaze you with tips and tricks on regular daily dentistry. Here's Kevin and Zach.

[00:00:28] What's up, Very Clinical listeners? Welcome back to yet another episode of the podcast. I'm Zach Miners coming to you from Kansas City, Missouri, with me as always, my trusty co-host, Dr. Kevin Harefriar. Kevin, what's up?

[00:00:41] It's starting to look like fall here in Cleveland, but I will say we have October baseball, which we'll save for later on. The two of us and also one of our special guests.

[00:00:53] How is the fall looking for the Cleveland Browns, Kevin?

[00:00:58] Ooh, you went to the hearts.

[00:01:00] We do not talk about the Browns.

[00:01:03] And your quarter-billion-dollar quarterback.

[00:01:05] We do not talk about the Browns in this session.

[00:01:11] They're off topic.

[00:01:12] Oh, man.

[00:01:13] Please do not mention them.

[00:01:14] Those are...

[00:01:15] So, the voice you hear there, one of our guests tonight is Dr. Tarun Agarwal from North Carolina.

[00:01:22] And also, you may have heard of this guy if you listen to this podcast, Dr. Alan Mead, all the way from Michigan.

[00:01:29] Greetings.

[00:01:30] What's up?

[00:01:31] The best radio voice in dentistry.

[00:01:35] I am wearing a lion's hat.

[00:01:37] Indeed.

[00:01:37] In the radio face.

[00:01:39] Yes, I have the radio.

[00:01:40] I have both.

[00:01:41] Yep.

[00:01:42] The guy is so great to be back on with you guys.

[00:01:45] We want to try to do video podcasts.

[00:01:47] Yeah.

[00:01:48] That's the reason.

[00:01:48] That's right.

[00:01:51] Kevin, bring us in.

[00:01:52] What are we talking about here tonight?

[00:01:54] Well, this is the bookend to our Change Your Mind series.

[00:01:58] And we have Tarun on and the three of us on as we started this back in July or previously.

[00:02:05] Was it then?

[00:02:05] Yeah, the funny thing is I listened to a little bit of it before we came on and we were talking about baseball and all sorts of stuff like that.

[00:02:13] And to the seller.

[00:02:14] It's all comes to, it's like an episode of Curb Your Enthusiasm or Seinfeld.

[00:02:19] We're tying it up with a neat bow.

[00:02:21] But we have Tarun on and we're going to start this off with our classic question that we've had for everybody that's been on at first.

[00:02:30] Tarun, if Zach and I come to Raleigh, if we come to Raleigh and we visit you, where are you going to take us out to eat?

[00:02:39] Oh, 100% I'm going to cook now.

[00:02:41] I have become, I just recently, I recently bought a house and the house came with a Yoder smoker, a fancy ceramic grill.

[00:02:52] And then I had my griddle.

[00:02:54] So now being Indian, I no longer leave the house.

[00:02:57] I cook at home literally every day outside.

[00:03:01] And I go to Costco every week and I buy meat for the week.

[00:03:06] I have a vacuum sealer, different spice rubs, different everything.

[00:03:11] And I'm not saying it's any good, but it'll be free to you, inexpensive to me, going out to eat is expensive.

[00:03:18] Home cooked meal.

[00:03:19] What would you make?

[00:03:19] Out of just curiosity, I want to know.

[00:03:21] So far I've made, go ahead.

[00:03:24] He would make meat.

[00:03:25] 100% baby back ribs.

[00:03:27] I've made baby back ribs, lamb chops, lamb filets, tenderloin, chicken wings, chicken drumsticks, all kinds of chicken, basically meat.

[00:03:39] And occasionally I'll put some vegetables on there.

[00:03:41] Super.

[00:03:42] I love that.

[00:03:43] Super.

[00:03:44] Ah, that's great.

[00:03:45] I didn't have that air, but I like it.

[00:03:46] Okay.

[00:03:50] That's awesome.

[00:03:50] Those are some good tools too, for sure.

[00:03:52] The griddles.

[00:03:52] I love cooking.

[00:03:53] They're great.

[00:03:54] I know you've got a nice one, Alan.

[00:03:56] I love, I love the flat top.

[00:03:57] I don't use as much as I should, but it is a blast.

[00:04:00] Oh.

[00:04:02] Okay.

[00:04:03] Tarun, the topic of the night is one major thing you've done like a 180 on clinically over the course of your career.

[00:04:12] You know, just something you've changed ever since those six year UMKC days.

[00:04:16] What's something you graduated with that you have absolutely turned around and wanted to share about?

[00:04:21] Yeah, I mean, for me it's dental implants.

[00:04:24] Yeah, I remember, I've shared the story before.

[00:04:28] I remember in dental school I passed out watching a tooth being taken out.

[00:04:32] And ever since that, I mean, that was literally my first year of dental school.

[00:04:36] Just watching the tooth.

[00:04:37] I wasn't even assisting, just watching from the background.

[00:04:40] And at that point I decided I wasn't going to be surgically oriented.

[00:04:44] And so for the first.

[00:04:46] Okay, I got to stop you.

[00:04:47] I got to say, did you actually, did you actually pass out?

[00:04:49] Oh yeah.

[00:04:50] If you ask my classmates, I literally fell down in the operatory up against the operatory walls.

[00:04:57] Passed straight up, passed out.

[00:04:59] I got a great story.

[00:05:00] Like a minute.

[00:05:00] Go for it.

[00:05:01] I was in advanced biology in high school, my senior year of high school.

[00:05:05] Two hours a day, biology.

[00:05:06] Honestly, I learned more in advanced biology than I did in all of my college and dental school years.

[00:05:11] It's a great class.

[00:05:12] At one point we watched an open heart surgery.

[00:05:16] Oh my God.

[00:05:16] This would have been in like 1988, 1989.

[00:05:20] So I mean this was like having video of this was pretty rare.

[00:05:23] You could see that on YouTube now.

[00:05:25] But so it was a class of nerdy people that were watching this.

[00:05:29] We're all, you know, probably pre-meds, pre-dents, that sort of thing.

[00:05:32] I passed out cold in my desk.

[00:05:36] And literally the teacher had to like slap me to wake me up.

[00:05:40] And of course, like literally, by the time the class was over, it was like fifth and sixth hour.

[00:05:46] And there's a break between fifth and sixth hour.

[00:05:48] The whole school knew that I passed out.

[00:05:51] And like between fifth and sixth hour, it was mortifying.

[00:05:54] Yeah.

[00:05:54] So I actually, I lost consciousness watching.

[00:05:56] Yeah.

[00:05:57] So I straight up passed.

[00:05:57] I lost consciousness too.

[00:05:59] Yeah.

[00:06:00] Yeah.

[00:06:00] Yeah.

[00:06:01] And I guarantee you having, I had a classmate that also did that.

[00:06:04] I guarantee you the way I know UMKC works.

[00:06:07] Everyone knew did that by within about two hours.

[00:06:10] I wore a sign and went and told everyone.

[00:06:11] I mean hell with it.

[00:06:12] Yeah.

[00:06:13] That's a smart idea.

[00:06:14] You know, for the first 10 years of my career in practice, I didn't even take out teeth or

[00:06:19] anything.

[00:06:20] And then it was by necessity that I started doing implants.

[00:06:25] With the 2008, 2009 recession, I needed something.

[00:06:29] And, and I was tired of sending my patients away and I needed to drive revenue.

[00:06:35] And, you know, fast forward now to 2024, you know, 80% of the work I do in my practice on

[00:06:43] a day-to-day basis is implant work at this point in time.

[00:06:47] So from passing out to basically 80% of the work I do, and it's allowed me to have a great

[00:06:54] economic career, but you know, dental implants and the associated procedures, revenue wise have

[00:07:01] have allowed me to work less than I've ever worked in my life, but yet produce the amount I need to

[00:07:06] produce to pay my bills, you know?

[00:07:08] And so what was going on in your mind during that period of time where you decided, you know,

[00:07:14] you said economic necessity, but what was the turning point that this was the path?

[00:07:19] Yeah.

[00:07:19] Because you could have done, I don't know, ortho or...

[00:07:23] Well, I wasn't smart enough to do it, though.

[00:07:27] A bunch of other people.

[00:07:28] For me, you know, I've always been, I had a technology bend.

[00:07:31] And so when, when CBCTs became somewhat reachable, I mean, they were still very expensive.

[00:07:37] Yeah.

[00:07:37] We're talking 160K for a CBCT back, back then in 2008.

[00:07:43] So, but that was somewhat reachable.

[00:07:46] And so once I saw that, I got into, it was all about guided surgery for me.

[00:07:51] And, and that just, that just, just started it.

[00:07:54] I mean, for me, it was all about the guided surgery capabilities.

[00:07:58] And, you know, back again, you know, my journey has been, you know, from 2008 to 2012, it was all single teeth.

[00:08:06] 2012, I started doing slightly more advanced work.

[00:08:09] And then around 2015, I started, started doing more full arch cases.

[00:08:14] And now that's a good percentage of what I do surgically now is our full arch implants.

[00:08:21] And where did you get your training back in 2006?

[00:08:24] Well, I took some training in Boston from a short implant company.

[00:08:29] I took a weekend course there.

[00:08:32] I took some YouTube, not YouTube training at the time, but then I've learned a lot on YouTube.

[00:08:37] I learned a lot from Carl Misch's textbook.

[00:08:40] And I, and I'm not being demeaning here, but it was bathroom reading for me.

[00:08:44] You know, and anybody that's a guy knows that's where you spend a lot of time.

[00:08:48] And I literally had a bookshelf in my bathroom and his, both of his books were on there.

[00:08:54] And I would literally read those over and over again to really.

[00:08:57] Till your legs were numb.

[00:08:58] Well, even, even beyond, even beyond my legs.

[00:09:02] And then, um, God rest his soul, my oral surgeon, best friend, oral surgeon, um, who recently passed.

[00:09:09] Uh, he was so instrumental in teaching me essentially, you know, through live patient experiences, uh, in his office on my patients, uh, and being there and give me the confidence to say, you know, I remember one day he says, I want you to try almost any, almost anything you want.

[00:09:25] I've got you back, uh, and we'll, we'll get you through it.

[00:09:29] And it really opened, opened me up to give me that confidence to really kind of just push myself.

[00:09:37] That's rare.

[00:09:38] That's really, especially, especially back then.

[00:09:40] I mean, it's a little bit more somewhat available now, but in the mid two thousands, late two thousands, uh, for a surgeon to say, I'll, I'll help you learn how to do implants.

[00:09:50] Uh, it was extremely rare at the time.

[00:09:53] Yeah.

[00:09:54] It's transformed my career.

[00:09:55] How did Tarun, when you went 10 years of basically not doing, even taking out teeth, how did you even get the confidence up to like, you know, even start just doing surgical extractions and stuff like that?

[00:10:07] Well, is that all from the old surgeon?

[00:10:09] Yeah.

[00:10:10] It's, you know, it's a great question, Zach, because knowing what I know now, uh, I was doing my patients a disservice back then.

[00:10:17] I was ripping out teeth then, you know, I, I was ripping out teeth.

[00:10:21] I was using a, I was, he sent barely using a curette to clean out sockets.

[00:10:26] I think I was just feeling things like, you know, like you walk by and you put a, you put your arm up against somebody.

[00:10:31] I mean, it was kind of like that.

[00:10:35] I didn't know any better back then, uh, how to take out teeth.

[00:10:39] I was ripping out teeth.

[00:10:41] I had no earthly idea how to do socket preservation.

[00:10:44] Uh, and you know, part, honestly, Zach, it was, it was foolishness to a certain degree.

[00:10:49] I was just dumb and willing to try almost anything.

[00:10:53] And, and that got me started.

[00:10:55] And then, you know, I'm a conscientious person that wants to do well.

[00:10:59] I mean, be making people proud of me drives me.

[00:11:03] And then, so that, um, you know, when you make mistakes, I would, uh, I would try to learn from them.

[00:11:10] I would say, I would, I would be retrospective and say, why did that fail?

[00:11:14] What did that happen?

[00:11:15] I'd ask lots of questions.

[00:11:16] I documented my work as much as possible.

[00:11:19] And I just strive to be better, you know?

[00:11:22] And, and so, uh, but, but Zach, look, I'm being 100% honest.

[00:11:27] It was 100%, not in a negative way, but it was 100% financially motivated to get into implant dentistry.

[00:11:35] Sure.

[00:11:35] Uh, at that time.

[00:11:37] Sure.

[00:11:38] I get it.

[00:11:39] I get it.

[00:11:39] So incorporating implants has been a common theme when we asked this question.

[00:11:44] We've heard a number of times.

[00:11:46] So I think if you're a young listener out there, um, I mean, I'm just going to throw it over to T

[00:11:52] bone.

[00:11:53] What, what would you say to a young dentist?

[00:11:56] I mean, I think we've both seen some young dentists.

[00:11:59] Um, 3D dentists.

[00:12:02] What would, I, I said this in the first episode that when we're at, at 3D dentists and teaching

[00:12:09] the implant course, I'm jealous of those guys because they're, they're getting a couple

[00:12:15] steps or many steps ahead of where I was at that point.

[00:12:19] But what would you, what would you tell a young dentist?

[00:12:22] Well, I think my answer may surprise you a little bit.

[00:12:26] Uh, number one, I'm going to say, um, always push yourself and make room for growth in the

[00:12:34] future.

[00:12:34] But what I will say is hold your horses a little bit.

[00:12:38] Uh, step one to me is let's get good at fundamental dentistry.

[00:12:42] Let's get good at root canals.

[00:12:44] Let's get good at taking out teeth nicely.

[00:12:46] You know, the, you know, I call it Insta famous and fake book.

[00:12:50] You know, everybody, all it seems like is it's full arch, full arch, full arch, full arch.

[00:12:54] And I'm a culprit in this myself.

[00:12:56] Uh, but I would tell you that if I had tried to dive into this level of implant dentistry,

[00:13:03] one or two years in three years in, I don't think I'd be sitting where I'm sitting right

[00:13:08] now.

[00:13:09] You know, I'm just very, I don't think it needs to take 20 years to get there either,

[00:13:13] but I do think it needs to take a conscientious effort.

[00:13:17] And to me, uh, I'm grateful that I didn't learn some of these skills so early in my career.

[00:13:23] I learned how to become recession proof first through doing good dentistry, sound dentistry,

[00:13:29] good communication, a good restorative basics.

[00:13:33] Implants require restorations and the more complex implants you get, the more occlusion matters.

[00:13:38] The more aesthetics matter.

[00:13:41] And I, I, as much as we teach and we make money teaching, I feel bad for the, some of the

[00:13:47] one year out, two year out that, that I know they just don't have enough at bats to know

[00:13:53] what they don't know.

[00:13:54] And so I would tell you that, look, there's plenty of time in your career to get good.

[00:13:59] Just go slow, go steady, get really good at fundamental dentistry.

[00:14:04] And then your time will be there.

[00:14:08] Great advice.

[00:14:09] I think that's extremely sound advice.

[00:14:12] I sure.

[00:14:13] Big time, big time.

[00:14:15] Alan, we have, we haven't placed in the implants.

[00:14:17] What's wrong with us?

[00:14:18] It's really funny.

[00:14:19] I placed some implants, uh, back in the Caribbean.

[00:14:23] Back in, there's quite a few, uh, they're still there.

[00:14:29] I'm not sure they were ever restored, but there's a whole bunch of them, a bunch of random sizes and random places.

[00:14:35] Kind of crazy.

[00:14:36] But I actually, I actually saw two patients of mine, uh, that I placed implants in, uh, just right after I did that.

[00:14:44] And honestly, they look pretty good.

[00:14:45] And I feel like, man, I was, I was working off of a pan.

[00:14:48] You know, I was right.

[00:14:49] I mean, I, I learned none of the good fundamentals and I got away with murder, but yeah, that like the stories you get that I guess on top of what Tarun is saying, there's a certain, there, there is a, a floor of the technology that you kind of have to have before you really focus on the regular.

[00:15:04] And I was, I, and at that point I was below that floor and I wasn't very comfortable for a reason, you know, they're, they're looking okay.

[00:15:11] But, but I had a couple that failed too.

[00:15:13] So I'm not, you know, I'm not, I'm not too proud to say that.

[00:15:16] You know, one thing I've kind of noticed as I get older and I have a little bit of gray in me is, um, I used to make fun of, of people my age when I was younger.

[00:15:28] Like, why don't they do this? Why don't they do that? Why aren't they more motivated?

[00:15:32] And, you know, as I've reached, I'm through my 25th year of, of, of dentistry now, not including dental school.

[00:15:40] Um, I kind of get it now.

[00:15:41] You get to a point where you're really comfortable.

[00:15:44] You're in cruise control.

[00:15:45] You know, you've got, you know, I've got three teenagers, I've got some various life situations.

[00:15:50] Uh, and I used to, I used to push people too hard, uh, to, to get better.

[00:15:56] And honestly, if they don't financially need it, if they're in a happy place, if they're doing good for their families and doing good for their practice, it's okay.

[00:16:06] Don't feel bad if you're not following the trends, but if you're going to complain about things, uh, but you'd not push yourself.

[00:16:14] I definitely have a problem with that.

[00:16:16] Uh, but, but that is so good.

[00:16:19] That is what you just said is so good.

[00:16:22] That's yeah.

[00:16:22] That statement was money.

[00:16:23] Yeah.

[00:16:23] Yeah.

[00:16:23] It's just for sure.

[00:16:25] And it's, it's amazing to me because you know, I'm a pusher by nature.

[00:16:29] Um, but you know, you get hit in the face and you get humbled in life a few times and you understand where people are coming from a little bit differently than before.

[00:16:40] Wisdom.

[00:16:41] Well said.

[00:16:41] That comes with age.

[00:16:42] All the way around.

[00:16:43] Super.

[00:16:44] Kevin, any, uh, since, uh, where, uh, where, uh, where would you go now to, if Taroone's recommending these implants, where do you think you'd go?

[00:16:52] Where in the world could you go to work?

[00:16:53] Is there anywhere to go these days?

[00:16:55] There's a lot of places.

[00:16:57] Um, are there any, if you go to Taroone's bathroom, there's a couple of books there.

[00:17:01] And on eBay and my books might be on eBay now.

[00:17:06] But my recommendation is straight from the bathroom.

[00:17:09] Straight up YouTube.

[00:17:10] That's all you need.

[00:17:11] That's all you need is YouTube.

[00:17:13] All right.

[00:17:13] But in all seriousness, obviously we do wonderful training at 3D dentist.

[00:17:17] I'd love to have you join us.

[00:17:19] Wait, three, never heard of you.

[00:17:20] And we have an app.

[00:17:21] We have an app too.

[00:17:23] Uh, there's, we actually do have an app.

[00:17:26] Um, and then we have implant pathway out in Phoenix.

[00:17:30] And there's a few other, uh, reputable places that I would encourage people to go.

[00:17:35] Uh, no longer do you have to go overseas.

[00:17:37] You don't have to go to Mexico.

[00:17:38] You don't have to go to Guadalajara, the Caribbean.

[00:17:41] You don't have to go, you know, and those, those things were, were necessary now.

[00:17:45] But I, I think there's four or five good places in the U S where you can get training.

[00:17:50] Uh, and, and I, I really do believe it's about an organization that fits your personality.

[00:17:56] So if you want to be digital, if you want to get good sound, practical advice, uh, then,

[00:18:03] then we're a great choice at 3D dentist.

[00:18:05] If you want to be non-digital and you want to be what I would, you know, what I call it,

[00:18:10] quote unquote, slightly cowboy ish, then we're not the right choice for you.

[00:18:14] And that's totally okay.

[00:18:15] You know, if you want to be a surgeon, if you want to be a surgeon light or essentially,

[00:18:20] then we're not the right choice for you.

[00:18:21] If you want to make implants part of your general practice, we're a fantastic choice for people.

[00:18:27] Awesome.

[00:18:28] Well, well said.

[00:18:29] Very good.

[00:18:30] Well, thanks guys.

[00:18:31] Uh, Tarun's going to be back as if you've been following the change your mind series,

[00:18:35] you know, he's going to be on for the next two Tuesdays in a row.

[00:18:37] So yeah, come back, catch him next week.

[00:18:41] Um, uh, Kevin's still not charging for the very clinical Facebook page.

[00:18:45] No, join.

[00:18:46] You haven't joined.

[00:18:47] It's not an app.

[00:18:48] You know, it's on Facebook.

[00:18:49] It's not an app.

[00:18:50] Is Kevin's smiling face and beautiful hair on the app?

[00:18:53] I am.

[00:18:54] Are you flexing that?

[00:18:55] It's a wig, dude.

[00:18:58] I went and tried to pull it off the other day.

[00:19:02] We need to Photoshop Kevin's hair onto Tarun.

[00:19:05] We do.

[00:19:05] Wait a minute.

[00:19:06] That's it.

[00:19:07] If I could look, I have myself with the toupee on.

[00:19:11] All right.

[00:19:12] Hey, thank you guys for listening.

[00:19:14] Again, Tarun will be back next week.

[00:19:15] We will see you next Tuesday.

[00:19:18] See ya.