Very Clinical: Planting Seeds and Placing Implants with Dr. Adam Frounfelter

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[00:01:30] This is a production of the Very Dental Podcast Network. 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.

[00:01:57] Very Clinical listeners, welcome back to another riveting episode of the Very Clinical Podcast. I'm Zach Miners coming to you from Kansas City, Moe. With me as always, trusty co-host, Dr. Kevin Harefriar. Kevin. Listen, hair is on point today. Looking good, man. Looks like you just got a cut. I did just get a cut. Looking good.

[00:02:16] I have a funny story. My barber is a patient of mine and way back in the day, in the 90s, before you guys were born, I made a deal with Butch, my barber, that he would cut my hair for free and I would give him free dentistry. And the only reason I did that is I really like Butch. We used to play softball together and he's a great guy. Yeah. Butch is getting up there in years and has some, had some health issues lately.

[00:02:45] So, I cheated on him last week and got a haircut from someone else because he was, he was not able to. So, Kevin, I just, I just lost my barber this last week also. To death? It's kind of a, damn near. He's losing an eye. Oh, God. To take melanoma. Oh, my God. Sorry to start the pot on a horrible note. Yeah. All right. Let's bring it all, let's bring it back up.

[00:03:14] We've got Adam Fraunfelter back again. Hi, Adam. How we doing? Thanks for having me again. We're doing great. We're happy to have you back. How are things there in Evansville, Indiana? Just another, another great day. Another busy day. Running kids around here and there. We have basketball every single night. But fun, fun stuff. Yeah, I heard basketball is big in Indiana.

[00:03:41] Yeah, it's one of those things, you know that, being a Purdue guy, you never got quite to see the level that IU has, but I mean. You know, I did watch, I saw Bobby Knight throw a chair on TV live. Yeah. Actually, I was in, I was a junior or something at Purdue, but anyway, that's a really big throwback. And speaking of throwbacks, tonight's bit is, I don't know why, is about the Brady Bunch.

[00:04:12] So, Zach admitted to not really being a big Brady Bunch fan, but what I did want to say is, as guys here, there's, you have a pick of sort of the females. And, or males, and or males on the Brady Bunch. Oh, boy. Yeah. You know, like. Yeah. Who's your crush? So, Adam, everyone's on the board. Okay.

[00:04:42] You have the literal board. Can I do a quick, can I do a quick Google? Yeah, go ahead. Marsha. Well, Marsha's, Marsha's on the board. Wasn't Marsha always, Marsha was always the, I mean, that was my. I, you got a couple wild cards, you got a couple wild cards there, like Alice. Oh, well. Okay. Teach their own, man. Yeah. So, go ahead, Adam. You can go first. I mean, Marsha is, I mean, it's in fact quintessential, like, it wasn't that the. Yeah.

[00:05:11] You know, even her sister, Jan, was jealous of her. She was so beautiful, right? Yeah. So, what is it exactly about Marsha? Is she just a little bit more mature or. Which way do you, when you say mature, what do you mean? Just, you know, like, not mature. Well, because she wasn't like a young child. She wasn't a kid. At some point. Yeah. She wasn't Cindy. Cindy, no. I'm looking at the names. No, no, no. Yeah.

[00:05:40] What, I wonder what, how old do you think Marsha was when she was in there? Like the actress. Yes. Yeah. Okay, that's a good question. I do, I hate that I do this constantly, but I did watch the first episode. Like. Okay, here we go. What's the answer to that question? Five or six. The Brady Bunch ran from 1969 to 1974. I was six. The actress, Maureen McCormick, who played Marsha, was born in 1956.

[00:06:09] So, she was 13 to 18? 13. I don't know. This whole convo seems creepy now. Can I go with the mom, just so I'm legit? I'm going with the mom. I'm with Florence Henderson. You're going to go with Florence Henderson? I retract my statement. No, I mean, it is what it is. I'm actually going to go with Alice, and I'm going to tell you why. She can cook you a good meal, and that's all I care about right now. And Sam the Butcher, I'm just going to say that's a lucky man right there.

[00:06:37] But I do want to do one. Pack in the meat. For his Alice. Oh, Lord. So, back in the early 2000s, there was a little bit of a Brady Bunch obsession amongst the Friar family. And I did find out that Greg Brady, Barry Williams, was in town doing a book signing.

[00:07:07] So, I actually got to meet Greg Brady in the flesh. I shook his hand and had him sign his book that I gave away as a white elephant gift at a Friar Christmas. And, I mean, there is nothing. You know, for someone born at the tail end of the baby boom to actually shake Greg Brady's hand, we probably just lost half our listeners who have no idea what I'm talking about.

[00:07:36] But the man's a legend. And, you know, I just, one of my TV heroes, Greg Brady, the man, the myth, the legend. Yet you gave it away as a white elephant. I gave it away. Yeah. I did give it away. Okay. Yeah. So, anyway, let's, you know, let's all look at our favorite Brady Bunch episodes this week

[00:08:03] and just reminisce when times were tough. And you, not really tough, but you could have an AstroTurf lawn on TV and that just seemed normal. Okay. Yeah. All right. Adam, we have a job to do tonight. All right. Let's do it. All right. So, we're going to pick on Zach a little bit. Not really pick on him. We're going to convince him. That's what I'm used to.

[00:08:28] To take the implant continuum that we both help teach at 3D Dentist. But first of all, from your own perspective, Adam, tell me about the implant continuum. I know that you and I get to be there and joke around and, you know, mainly be goofballs while we're there. But there is some learning that happens. So, tell me what's going on there first. Yeah.

[00:08:56] So, I think we do have a great time, first and foremost. It's fun for everyone to be at the retreat there together. You hear the phrase, you come to learn implants, but you go home with so much more. Just because being at the retreat, it allows everyone to kind of talk about their practices, about their problems. People let their guards down. Yes. Let their guard down. Yeah.

[00:09:21] And it just, to me, every time that I go to teach, I learn something from one of the other attendees. Of course. Yes. I'm learning something from them, which I'm taking back and then I'm telling Allie, hey, listen to this. This is a great idea. You know, you get to hear Kevin speak, which is obviously the keynote 100%. Yeah, of course. Yeah. And then you have Rick. I have a day.

[00:09:48] I should say Dr. Rick Sullivan does, just a great dude, but he teaches the extraction and grafting. So, go ahead. And what's your, tell us about your lecture. What are you teaching us there? Because it's really the meat of everything, actually. Yeah. So, I'm teaching mainly just the implant side of things. So, why we're choosing, say, why a conical connection versus an internal hex, why one

[00:10:16] is better than the other, you know, parts of the implants, we're learning about that. Just basically, we're trying to stop the problems before they happen. We're trying to teach them the things that I'll always say, ask me how I know. So, what did I screw up doing that I want to stop so they don't have to deal with the same problem? Right. And so, we just go through everything.

[00:10:43] And I think the thing that was different for me versus some of the other CEs that I see and that I hear from, you know, say my brother that took the course is that Monday he got home, he placed an implant that day. He's able to implement it right away. He stacks up the schedule. Everything that is taught, they can go home and implement. And I'm not saying that everything else is just worthless when you go to those courses.

[00:11:10] But I do believe with 3D, with the tooth replacement therapy, with the implant continuum, it's able to be implemented when you get back to your office on Monday. All right. So, you said a phrase there, tooth replacement therapy, which we, that really is sort of our jam there. Um, what does that mean to the, to the listener? To the listeners, to me, to, to, to Zach, to everyone here.

[00:11:38] Um, I, I think tooth replacement therapy is giving them an option to, to say yes to the best treatment. And in most cases for me, uh, if a tooth is going to be lost or whether it's from an emergency, whether perio, whatever, all these issues could be that causes the, the, the tooth to be lost, a failed endo, um, the best replacement is going to be an implant. And we want to give them a chance to replace that, um, through the whole thing.

[00:12:06] So if it's time to replace it, we're telling them, Hey, this tooth needs replaced. And at our office, tooth replacement therapy therapy means, uh, if they have a tooth, that means extraction graft implant and restored all together. It's, it's all packaged together. Right. So the whole thing starts from the diagnosis, obviously, but the extraction and graft and leading up to the, whatever the restorative is, what we're basically teaching is onesie twosies.

[00:12:36] So the screw routine crown at the end, um, which is, you know, from part of my lecture there, that's what the patient wants. Uh, our students want to learn how to place implants or our attendees want to learn how to place implants, but the patient ultimately wants a tooth there. And so bearing that in mind from the, uh, starting with the end in mind is really, uh, key for what we're teaching there and, you know, what our attendees learn. Yeah.

[00:13:04] And Kevin, Kevin just said it starting with the end in mind. So we do crown down, um, we're placing the crown where it's supposed to be in digitally. Then we're able to take that and get the implant, um, with, with the crown that we want to the finished product to be, we're able to move the implant where we want it digitally. So then we can guide everything to, to, to, to have that exact crown. Right. So Zach, you have the building blocks right now.

[00:13:33] How have things been going with your cone beam, which is relatively new. It it's, it's super new. Um, I am, I'm, I'm getting a pretty decent handle on reading the basics, you know? So, and I'm, I'm taking them and having my staff, you know, take them not as frequently as you've told me to take them, but I'm getting there better than, better than I thought I would do. So I, it's, it's a, it's been a good start and I dig what I, I dig the images.

[00:14:02] I, I, I'm loving all of the different angles you can, you can see and what's going on. Talk about, uh, I've already, you know, kind of told Kevin as I've been going along, wow, you know, like I probably could have gotten that endo done without, uh, without that cone beam, but it was nice to have it as kind of a roadmap for what I was doing or a couple extractions. It's like, okay, that, Hey, there's a curved route that I'd have to find out about later. Very cool. So I'm getting there. So I've got the scanner, got the cone beam.

[00:14:28] I got to get some confidence and, you know, I'm on my way, on my way, baby. So, um, you know, Zach also has a medit. So he's, he's got the, what we would call the, the infrastructure there already to, uh, you know, make guides and, and, you know, sort of do what we do.

[00:14:49] So, um, the, the nitty gritty of what we're, uh, teaching, um, I always come down to, and we talk about this behind the scenes that the extraction and graft is really the most difficult part of everything. So can you, uh, both Adam and Zach, can you comment on that? Zach, you're not doing any grafting now. I know. No, I'm not, I'm not grafting yet.

[00:15:14] So, um, how, talk to Zach about how that transition can be made. And, you know, really, again, it's the most difficult part in my opinion. Yeah. And we say that at the course too. Um, when we have the patients, the live patient portion that Thursday, all we do is extraction and grafting and you'll see and hear at the end, like what was the hardest Thursday just is,

[00:15:41] is so tiring for, for the attendees and, and for us as the mentors. And for us, yeah. It's, it is tiring. But, um, I mean, I think that the way we grew our implant practice was there were so many emergencies that walked through the door that needed the tooth out. Hey, it's Kate, the dental assistant. And it's time to get very clinical in this episode's very clinical corner. Are you ready, Dr. Mead? I'm ready.

[00:16:11] I want to ask your advice on storage. Sure thing. What's the question? So my team is always looking in multiple places for the same or similar materials. And I feel like no one knows exactly where anything is. Do other practices struggle with this too? Yes, many practices do. And I'll be honest, legacy errors are to blame for this current state of quote unquote organization in dental practices. So tell me what you mean by legacy errors. A legacy error is when somebody starts a process or a system with no scientific background or

[00:16:40] research or education. They just make the decision and then train their successors on the way that they want things to happen. And then what works for that one person. So that sounds like it could cause problems over the long run. It can, especially when the person that sets the system leaves and then the next person comes in and then makes changes. And now we're creating more confusion because where it was isn't where it was the last time. How do you change that? Or how can you prevent it? Create standard operating procedures and then define spaces for the procedure specific materials

[00:17:09] and then the general disposables as well. So give me an example of that. Procedure specific materials are the ones that you need to actually perform your procedure. For example, bonding agents, cement, sutures, gutta percha. Often they're expensive and expirable. And those should be stored in a central location where their quantities and expiration dates can be monitored closely. What about the general disposables? Those are the items that we need for pretty much every single patient. PPEs, barriers, and cotton products are to name a few.

[00:17:35] And those should be stored in a separate room or closet due to their bulky packaging and quantities. And we don't want to waste valuable space and central sterilization on those items. So two storage spaces for dental materials beats the 15 places that we have them. Absolutely. Listeners, if you want to avoid legacy errors and have a timeless organizational system, check out the show notes on where to start. And that emergency and being able to provide the extraction and graft led to so many implants.

[00:18:04] Not right away necessarily, but a lot of those patients would get the graft done. And then down the road, you know, they would get the implant too. You're planting seeds. You're planting a lot of seeds. 100% perfect, Zach. Yeah. And you're, you know, I always say to the patients, we're building the foundation for your future implant. And so what, you know, what we're teaching and I'm sure what you have to be doing, Adam, is the, you know, PRF with sticky bone.

[00:18:35] So walk us through how that happens in your practice. Yeah. Like, yeah. Go ahead. Go ahead. No, go ahead. So, so for us, um, we, we, we, and something that's cool about the course too, is you're able to bring your assistant. Um, so they get to learn from, uh, T-bones assistant, uh, Masha, who's just phenomenal. And, uh, she'll, she'll teach the assistants how to draw blood, um, then how to spin it.

[00:19:02] And, um, so we have a sticky bowl, which is basically, um, PRF mixed within our cortical cancellous bone. And then it'll set up and, uh, or coagulate. And then we, what's amazing is if you've ever done it without, uh, sticky bowl versus with sticky bowl, not only is it easier to work with, but you use less, you have to use less

[00:19:30] bone, uh, just because there, there's, there's more availability when you, when you, when you mix these two together, there's just more substance and you can even, it's packable. It doesn't, it's, it's just, it's so much better. And if you ask my assistants, they would tell you they like working with it better because it's not falling off the, the, um, spoon or anything like that. So what I do is I literally numb the patient up. My assistants draw the blood, they go spin the blood, they bring it back.

[00:19:58] They have it set up, uh, and they'll already have mixed the sticky bone. And I sit down, take the tooth out, place the sticky bone, uh, put a membrane over the top suture it. We're done. Yeah. So, um, and I will echo that introducing the, um, PRF into the practice and the sticky bone really from an efficiency standpoint is well

[00:20:25] beyond not using it, which I did for probably a year before I, um, you know, drank the Kool-Aid and, and switched over. So, um, in terms of handling, there's no question, you know, the rare times that you can't get blood on someone for whatever reason that just, you know, that's one of those days that really sucks. But, um, for the most part, you know, you know, 95% of the time we're successful with that.

[00:20:54] Um, and it really is helpful. And I do think that that's, uh, in terms of some of the other implant courses out there, it's something that we really emphasize and then, you know, really, really practice. Um, and then, um, moving on to, you know, that transition time while they're healing, what's

[00:21:17] your, what's your protocol there for after the graft is placed and what steps are going to come next for you? Yeah. So like I said, place the graft and put a membrane there, uh, over the graft. Um, so basically a non-resorbable membrane, uh, depending on if there's, you know, any other bony defects, sometimes we do place a resorbable membrane underneath, uh, the tissue, but most of the time it's not that.

[00:21:44] Um, and then we bring them back in a month and pull the membrane. Now for us, I don't know the rules for everyone, uh, what the assistants can and can't do. They're able to just pull the, the membrane here in Indiana. They can just pull the membrane. So most of the time I'm, I'm not even in the room unless there's an issue. So they pulled the membrane. Sounds like a great album name, by the way. Perfect. Um, I was PG there. That's true.

[00:22:14] I was, I behaved myself. I didn't think that was what you were going to say to be honest with you, but that's, that's all good. Yeah. He's, yeah. He started. My favorite track on pull the membrane is sticky bone, but go ahead. Yeah. So they pull it, take a picture. And if there's no problem, the patient's on their way. And, um, yeah, I mean, then we see them after that. So that's a month after the extraction and graft.

[00:22:38] And then, uh, we see him after that two months later to do a scan and a CT, I should say a, a digital impression and a CT. And that's to make our guide. And then we bring them back and, uh, go forward about four months after extraction. Yeah. So in the class, we always recommend that our attendees starting out have their guides made by a lab. Um, are you, uh, you, you definitely are 3d printing your own at your office there in Evans, beautiful

[00:23:08] Evansville, Indiana. Yep. Yep. So we use, uh, I started with, uh, a great program, Exocad. Yeah. Um, and so we do all of our own design and I actually still, Allie will tell you that I spend too much time doing it. Um, so she made, uh, Dr. DJ and his, one of his assistants, Emma, um, go to the 3d printing course with Tim because she didn't want me doing all that stuff anymore.

[00:23:35] So, uh, so, so now DJ and Emma are doing all theirs, but I still like to go in and make some for him if I have time. I just enjoy it. It's like a video game. Exocad's really cool. Yeah. So I should say we, we take that digital impression and we take the CT mesh them together in the program and then you're able to do everything there. It's really cool. Yeah. I, what, what nerdy, nerdy favorite things to do is get to the office at six 30 in the

[00:24:03] morning and design guides when no one else is in the office and no one can bother me and I can get a lot done. And you know, it's just fun. It's like playing a video game. It's, it's, it's again, not something I would have thought I would have been doing in 1989. Uh, which I, you know, I like to say all the time, but it's, you know, it, it really is, um, one of the more fun parts of our day. All right. So we've got a guide made, however you're going to make it. What's going to come next?

[00:24:33] Uh, the next is we'll bring that patient in, um, what we teach and, um, and ask me how I know, uh, what we teach is flapping the tissue. And what's really cool about the flap is the flap design allows the, the flap to lay and then the, the surgical guide to be placed. So it just holds the flap back also. So, so your assistant is in there holding the flap back. You're not holding the flap back.

[00:25:00] It's all guide, um, driven and, and, um, controlling that flap also. And then, uh, a lot of people will tissue punch, but, but that's where we see some, some issues with, with the epithelial downgrowth and things like that. So, uh, so we flap it. Um, and then it's, I mean, the least stressful part of all the implant placement is doing the osteotomies. Mm-hmm. It's all guided. You know where it's going. You know, it's not going to any vital structures.

[00:25:32] Um, in a way, I hate to say it, but it's almost like you feel like you're, you're not doing much because. Feels like you're cheating. Yeah. It feels like cheating. It does. It feels like cheating. That's what, that's what my brother Tyler said. He's like, I never realized when you were trying to tell me about these guided, it is so much easier. It's easy for me to play some. Yeah. So, uh, during the implant planning appointment with my patients, I explained to them how the guide works and what it does.

[00:25:59] And I usually, you know, make an analogy like this is a template, um, cause people can understand what that means. So I point to the screen, you know, whatever we designed up here, uh, will be transferred right to your mouth. And the guide is like a template. And I always make the joke, like all the thinking will be done, you know, in the background. I promise you, I'll be thinking during your surgery, but I won't be thinking about all these different angulations that I could possibly go wrong with doing freehand.

[00:26:29] So I usually get a laugh out of the patient with that, but honestly, I'm not thinking at all during that. That's not true. Um, you know, it, it, it does become very, uh, rote. Um, and, and easy once you've, you know, done 10 or a dozen it's, it, it's remarkable. Yeah. And what's, what's crazy to me is the number of patients.

[00:26:56] Um, once, once you, once you tell them that you can do this, Zach, the number of patients that would have said, no, I don't want to go anywhere else. I don't want to talk to another front desk. I don't want to go to another parking lot. Once you say, oh yeah, I can take care of everything here immediately. They're like, yep. I trust you. I don't want anyone else touching me. I trust you. I want you to do it. I do. I do.

[00:27:22] Honestly, I 100% believe, believe that, you know, for sure. Because I think all of us that aren't implant placers have probably done some bridges where we didn't really, we would have rather the person done an implant, but the person just wasn't going to leave. You know? And I think I, 100% I know I've done that or even, or any number of different kinds of things where it was like, look, either you're doing it or nothing's going to happen.

[00:27:51] But, you know, people are very honest with that. It also keeps you out of doing something heroic that's probably not going to last, you know, a long time. Ask me how I know. Yeah. Me too, Zach. Man, me too. Yeah. I mean, that still happens from time to time, but it happens less. And I liken that, you know, I don't want to speak too frivolously, but I liken it to

[00:28:16] having a superpower because if that tooth fails, all right, I can replace it now. I mean, I know that I can. And like, I, you know, I had a patient today that fractured off number 13 at the gum line. I'm like, okay, I know I can take care of this for you. You don't have to go anywhere else. You've got this. I'm not going to try to re-cement your crown with some, you know, whatever luck and VanderWaal's

[00:28:42] forces trying to hold this in some sort of magnetic force from on high. It's just, it's taken that all of that. I don't know, whatever that thing is in your gut out of the equation, we can just take care of it. And so anyway, all right, so we've placed our implant and what happens next? So implants placed.

[00:29:08] And I think another being at some other implant courses and taking some other courses that I have and knowing some other friends that have taken other courses, 3D is very different at this aspect, in this aspect. So we placed the implants, Zach, and the day of, we have a instrument called the beacon, okay, that Kevin's so much smarter than me. He can probably explain it better. But basically we put a peg down into the implant, you screw it into the implant.

[00:29:36] And it, it gives you a reading that basically is telling you the interface of bone to implant. You know, again, people way smarter than me that could explain this. I'm guessing it's some kind of like a magnetic reading, something along those lines of how the bone and implant that the interface is. And if it's above a certain number, which for us is 70, it'll give a green light on the beacon and it'll tell you the number, say 75.

[00:30:04] And then we do it from buccolingual mesial distal and get another one at maybe 78. And since they're both above 70, we're going to do something that's, that's different than anyone else. And, you know, like my bio horizon rep will say, he's like, no one, no one else does that. I'm like, I know that I know, but, but I'm telling you this, this works. And so we'll scan day of placements actually. We, we put our, I've heard Kevin talk about this. Yeah, absolutely. Yep.

[00:30:31] So we, uh, that day then, um, we go ahead and depending on what, what your office is, um, we, you scan it. Uh, if you send it to a lab, that's great. Send it to the lab that day. You get it back, put it in your, um, wherever you store your crowns or, or implant crowns and save it till they come back for in, in three to four months. Yeah.

[00:30:55] So when I give my part of that lecture, I, I, I emphasize this is what makes us different. Um, that, uh, scanning at the time of placement, not only is it a time saver, it's a huge production boost. It saves the patient extra trips. It saves you extra chair time. And it's just, it's again, kind of like magic. It just, it just works.

[00:31:23] And I know that people have a hard time wrapping their head around it, uh, initially, but once you've done it a few times and see that it works, it's, it's just great. I think it can be argued, Kevin and Zach, I think it can be argued that it's the most productive appointment that you can have. Um, and again, it's all going back. We're not, we're not scanning, um, for, for the implant crown. If it's not a good, uh, interface, we're not doing that.

[00:31:50] If, if it's not a good interface, we're putting a cover screw on there. The traditional way, the traditional way that it's been happening for a long time. Yeah, sure. I get you pick your, pick your spots. Yep. You know? Yep. It's that, I mean, that applies to a lot of different things. It's like an endo, you know, some, some are going to get done the same day and you can put the crown. Some aren't, you know, I mean, there's good candidates and bad candidates. Absolutely. I get that. Yep. Yeah. All right. So we've scanned same day. Then what happens? Uh, scan same day.

[00:32:19] Uh, I'll be honest. I put, I kind of, I put a cover screw on everything. I don't put healing abutments on anything just because of the chance of introducing bacteria around it or somehow getting biting pressure on it and causing failure that way. So I do put a cover screw. I suture everything closed. From there, we bring them back. And the goal is if everything went great at the placement appointment, you scan day of

[00:32:47] when they come back at that three to four month period, um, we uncover. Uh, so basically uncovering for me is numb them up, uh, do a incision directly over the top of that healing screw. Kind of pushing that tissue back, seating the crown. I actually do not suture it at all. Um, and letting that tissue heal.

[00:33:16] Yeah. Okay. And so the crown becomes the healing abutment. Like I like to say, um, which is really what the ultimate is what you are. We're talking about, you know, your everyday average posterior tooth. Yep. Yeah. This is different if it's, yeah. But, but again, we're going back to Kevin, Kevin hit on crown down. Um, you're letting that crown dictate the tissue.

[00:33:42] You know, what we're used to is, is the lab, um, the lab smart. So they know a less problem for, for you. Meaning if you're, if they're not pinching on the patient and the patient isn't jumping and mad at you cause you're pinching them. If they make a crown that is, is not pinching them at all. They went. So most of the time we don't get a good looking crown, honestly. Uh, it looks like a mushroom on a stick basically, you know?

[00:34:10] And, and so we're, we're letting this, this crown then dictate it. And I think it's amazing. You see some of these pictures and the tissue is, is just beautiful. It's, it's beautiful once it heals up. All right. Uh, Kevin, are you, are we, are we done with the crown? I gotta, I gotta, I gotta get a question. I don't want to interrupt your like. We're good. You're good. Throw it at me. All right.

[00:34:34] So here is me considering this implant thing or a listener that's, that's listening to this. What is like, what's like a litmus test of like a minimum, you know, surgical skillset you feel like you need to have to feel like, okay, I'm going to go to this and I'm actually going to like, not, not feel like an idiot. And I am going to be able to like, I'm going to be able to take out the tube. I'm going to be able to do this graph.

[00:35:02] This is going to happen versus me just signing up for something that I'm not going to feel comfortable with. What's like, is there any kind of like, give me like a, what's a readiness like index for this? I'll let Adam answer that. Okay. I think it's, I think it's, uh, I think it's different for everyone. Um, what's interesting to me and Kevin, Kevin can hit in and whenever he wants here, we have

[00:35:28] people that come in and say, Hey, I've taken, I take out hundreds of teeth a year. And then when we get in and they start taking them out, it is, it's the complete wrong technique that they don't, they're not using the correct instrumentation, so on and so forth. So I think it's, uh, I think it's a belief in yourself that I know I have some skills here, but I know I want to do better. And it sounds to me, Zach, like, like you, you take out teeth. I've heard you say that.

[00:35:56] So, so to me, you've already, you're already doing, you're already doing half the battle. Now it's that first day when you learn from Dr. Rick Sullivan about the extraction graft, he may teach you some techniques, but you already have the background. You've taken out a lot of teeth. Sure. You've had the teeth that have, have wore you out. Um, so you're never going to look stupid or anything like that. I, I think it's a self-belief that I'm going to go in there. I'm going to learn how to do it correctly.

[00:36:25] I'm going to, I'm going to do better. I'm going to be the best at it. And then from there, it's just, you, you, you go for it. So I'm going to answer that a little different way, but I a hundred percent agree with Adam. I think what we're teaching, it's like you're, um, a major league hitter and you're, we're going to, we're going to major league hitter. I'm not going to sign up for this, man. I'm making too much money. Um, so no, I'm going to not subscribe.

[00:36:54] We're going to go, we're going to go back to fundamentals. Okay. And, um, we, we may, uh, introduce a little bit of a different approach and you just got to trust your coach that he sees something in your swing that, you know, anyone can swing it at the ball. Anyone can get, get a base hit, but we're going to just like correct your swing a little bit.

[00:37:23] That's all we're ever doing. So I guess I'm, I'm looking more like, okay, let's just say I'm the, I'm the person who's, I've never picked up a hand piece to section a tooth. That's just not me. If it's that I'm referring it out. Am I not ready? Well, I can pick up. I'm not talking about me specifically. We'll teach you how to do it. Yeah. Okay. We'll teach you how. And there's a lot of attendees that come in that haven't sectioned teeth before. Okay. And I, and I, I think even this last time or the time before people have said that I've

[00:37:52] never sectioned a tooth before. Or I hope I get one to section or something like that. Like you'll get one. We'll make sure of it. That's what we always say. We want them to, to, to do that while we're there because if something's going to ever go wrong, heaven forbid, we can be right there to fix and show them what, what we could have done differently. So on and so forth. Or like, you know, Hey, I, I only know one suture, the regular, you know, uh, loopity loop two overs to one under. That's the only one I know.

[00:38:21] Like, am I good? Do I need to like, you know, do something before I get there? You know, again, we'll, we'll teach that. They'll show you, uh, we'll show you all of the different suturing. Uh, we're trying not to get too crazy with the sutures that we may place. We're trying to limit if that, if that suture, that just an interrupted suture, like you just said, if that's what you do, you can do just great with that. Literally an interrupted suture can do everything, but we'll teach you more. We'll teach you more techniques.

[00:38:50] And, um, I mean, I think that suturing is the hardest thing. If you look at the, the, the thing that, that, that most patients from the, the life patient session come back for it's sutures coming out too early. Okay. Yeah. All right. Well, cool. Thanks. Thanks for, uh, answering my basic, uh, basic question there. Zach, you would be, you would be the, I can already tell you'd be the gunner of the course. You'd be the guy. Let's not, let's, let's not go too far.

[00:39:20] Let's not go too far. All right. Hey, we're, we're about up at it. Um, any, uh, any, any final thoughts, any, any take backs, apologies? If you want to learn how to place implants in 2024, go to the 3D dentist, uh, website. I think it's February something or other is our next one and, uh, sign up and come to the retreat. Is there one in the fall? Is there, is there, is there, is there a fall one yet? Or is there not? There's probably, there's one in September, uh, around my birthday. Hmm. Okay.

[00:39:51] Yeah. There's usually one in, in June, July timeframe, one around September. Yeah. What are you in for? Is that like a, like a, is it a three day thing or is it a week or what are we talking about? Most people fly in Sunday evening. Uh, and then we leave Saturday about noon-ish. Okay. Yeah. Right on. It's a fun week. Thanks for taking the time. Hey, I appreciate y'all having me. Thank you. Yeah. Yeah. I think next week we're going to have Steve Borhold on.

[00:40:18] Oh, well mine's going to get buried then. I won't, no one's going to hear from me. All right. Now I appreciate you guys very much. I appreciate you doing this. Yeah. All right. Uh, for Adam, for Kevin, this is, uh, Zach. We appreciate you guys listening and we will see you next Tuesday. See ya.