Very Clinical: Talking Invisalign

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[00:01:33] Welcome to The Very Clinical Podcast. In about the time it takes to do an M.O.3, we will entertain and amaze you with tips and tricks on regular daily dentistry. Here's Kevin and Zach. What is up, Very Clinical Nation? And welcome back to another episode of the Very Clinical Podcast. This is Zach Miners. I'm back. You're back. And I'm coming from Kansas City, Missouri. With me, as always, my trusty co-host, Dr. Kevin Hare Fryer. Kevin, what is up?

[00:02:02] Well, sitting in for me today is Barry White with his sexy, sexy voice. I'm doing great. My voice sounds a little weird. So if you're listening and you need to adjust the treble tone or the bass tone in your stereo, your car stereo, it's just me. I've got a little bit of laryngitis, but I think I'm going to be fine. Surely Alan can remix you. Doesn't he have that kind of capability? He can probably make me sound like a chipmunk, like Alvin and the Chipmunks.

[00:02:32] Yeah, there you go. That'd be fun. Or you could just turn your podcast speed up to one and a quarter. Or something like that, and my voice will rise just from that. What speed do you listen to podcasts at? Mostly one, unless I want to blow through something quickly. Okay. But most I'll go to one and a half. After that, I can't really hear that well. No, one and a half, I can't do one and a half. I'm a 1.2, 1.3 kind of guy.

[00:03:01] I don't even like to listen to myself in anything less than 1.2. We sound better at 1.4 or whatever. Oh, really? Yeah. Okay. I've done it a couple times. All right. And this is what it sounds like. Kevin, this is Thanksgiving week. It is. Tell me what you're thankful for. What am I? Don't do that. No, I'm not going to tell you what I'm thankful for.

[00:03:25] But I want to know where Thanksgiving ranks on your favorite holidays, O-Meter. It's number one. Hey, same. Yeah. Same. Hey, high five. We've talked about that before, but let's reiterate. It's number one because no expectations of presents. Nope. No cards. No cards. Just food. Just food. I came to this realization probably about 10 years ago. I was eating Thanksgiving dinner, and I looked around at my family. I'm like, this is cool.

[00:03:55] You get to sit around with your family and eat. That's cool. And then maybe watch some football or whatever. Or not. Who cares? Yeah. Or not. You're right. And talk to them, hang out. Yeah. Or not. But like, yeah. Less commercialism. No commercialism. I mean, what is there besides buying a turkey, which I'm not doing this year? Nope.

[00:04:22] I'm rejecting traditional Thanksgiving norms this year. What are you doing? I'm going to smoke two whole chickens in the big green egg. Okay. So they're birds. All right. But they're not turkeys. Because, I mean, it's not that great, really. Turkey. Are you saying it's played out? Yeah. Yeah.

[00:04:46] And I'm saying that out of the many attempts that I've had, I'm not good at it. I mean, I'll admit in like a meat rankings, even a bird meat rankings, that, you know, turkeys, you know, it's a 4 out of 10 kind of bird. What are the odds that you would, in the middle of March or July, cook a turkey? A whole turkey? Zero. Nobody does that.

[00:05:14] Only because my kids will probably shoot a turkey because they're, we're going to do the hunting thing. Yeah. And so they're going to want to, yeah. But other than that, no. Yeah. Nah. I mean, you might as well just order a pizza or cook a steak or something. Are you, at a deli, would you get a turkey sandwich? I would. That's the, that's the enigma of Kevin Fryer. I do enjoy a turkey sandwich.

[00:05:44] Okay. With bacon, you know, like the club variety. Right. Yeah. Like a club type of sandwich. Okay. How about you? I, I, so, um, uh, well, no, I'll, I'm going to ham if we're talking like, you know, my subway order or Quiznos or whatever, you know, one of, one of those, but no. Um, I've always had kind of a weird Thanksgiving thing. We, we probably talked about it in some of our previous Thanksgiving episodes, but I, we always go to my mom's hometown, which is in a small town, um, in, uh, central Missouri, home of

[00:06:11] David Koechner, actually of Anchorman fame. So, um, and in that particular town, no one cooks. Everyone buys their entire Thanksgiving spread from the local Catholic church because that's like their massive fundraiser for the year. Interesting. So everyone just lines up and gets these. Line up in the car? Or you have to go in? Oh, I mean, they go in, they go in. Okay.

[00:06:39] So you can either sit down and eat there or you can just pick up trays of food of like, you know, a turkey here, stuffing here, you know, and I mean, it's pretty good, but it's also all I've kind of ever known except for a few random years where we didn't do it. But that's my most frequent item. So yeah, that's my, that's my Thanksgiving. Gonna have my sister and nieces over and we'll eat and play games probably and whatever. There'll be some pumpkin pie, I'm sure. I don't like pumpkin pie. I do not like it.

[00:07:09] Hard, hard knowing pumpkin pie. Uh, are you going to shop on Friday? No way. Online or otherwise? There's no way I'm doing that. I might be, um, seating that veneer case on my niece cause she'll be back in town. Oh, that's right. For those of you who aren't in the Facebook page, which you should be cause Kevin still hasn't started charging for it yet. He posted a really great case of a, of a prepped veneer case on his niece.

[00:07:37] So if it's back and she wants to, we'll do it on Friday. Just it's, it's a weird thing cause she's coming back and forth from North Carolina. Did you do that in Emax? Yeah. Yeah. Okay. Very, very cool. Uh, the other Thanksgiving tradition my family has is the, we go to the Kansas city mayor's Christmas tree lighting on Friday. It's on Friday night. And, um, it's a nice little kind of a kickoff to Christmas thing. Just something we've always done.

[00:08:06] Neat little lighting ceremony, little singing lights, fireworks. Yeah. Pretty cool. We'll probably put up the tree on Saturday or something like that. Saturday. Yeah. I would say, yeah, that's probably a, yeah, I agree. That's the Saturday, Sunday type activity. Yep. All right. Uh, Kevin, here's our, um, our topic of the week. Uh, we have been talking about, um, Invisalign, but not the process, not the, not the clinical,

[00:08:32] not any of the clinical stuff behind it, but the soft skills. Yes. If you will, behind Invisalign and this topic got born out of the fact that I, if long time listeners know Kevin is a power Invisalign provider, are you like diamond level gold platinum? Um, something, what are you? I'm like rare earth metal, uh, rare earth metal. Yeah. I'm like, uh, I can't even think I, my periodic table is slipping.

[00:09:02] I don't even know what I am. I don't really care. That's how, that's where I'm at. I don't care. He does. He does. So good. He doesn't even care. Uh, he does. Uh, he does a lot of trays and I have done zero cases of Invisalign, but I do send, I have had more adults actually participate in the Invisalign process through one of my orthodontists in the last few years. It's started to make me wonder why I'm not a provider because I'm watching thousands. I wonder a lot of things about my decisions.

[00:09:31] I'm just going to say, I'm doing a whipple today. If you read a chat, um, did seven cases today. Seven? Seven. He sold seven cases today. That's a good day. After taking our good friend, Matt Stanbridge's class. So shout out to Matt and Jacob. I think he made more money than the like 10 fillings I did for sure. That's what I'm getting at. Yeah. Yeah. I think he made a lot more than that.

[00:09:56] Um, so anyway, I, as I, I'm not a provider, but I was asking you because, you know, on the dark side of Invisalign, the, all three of the people that were in had some sort of a complaint either about the process where their teeth were. So, and sometimes they were complaining about a good result. In other cases, they're complaining about something else. So you were talking about how through your numerous reps and you might even have more

[00:10:22] reps than, than the orthodontists I send to, you know, uh, of like of adult ortho and how it goes through of how you troubleshoot some of those things and gave me some like, you know, word skills and tips for navigating the process. So where do you want to start? I think we should just start at the beginning. Okay. That's a good place to start. So what? Yeah. It's, it's always the best, unless you're in some sort of Quentin Tarantino movie, then you can start in the middle and work your way out or.

[00:10:51] What's that memento back with the backwards movie? Well, Pulp Fiction starts sort of in the middle or the end. I don't remember. Okay. Good movie. Fair enough. Anyway. Um, but memento. Yes. Also, that's what we're talking about. So I think that the, the verbal skills from the beginning in terms of, um, quote, selling the case, you know, like I've talked about before on the podcast and other places, um, the

[00:11:21] simple question, uh, our hygienists ask, have you ever thought about straightening your teeth leads into, uh, you know, a yes. And let's talk about Invisalign or a no, let's talk about Thanksgiving or whatever happens to be the topic of the day. Sure. So that, that little, uh, verbal skill, just that there has, you know, a lot of allowed us to do a lot of Invisalign. Sure.

[00:11:48] Um, so, but like a lot of, uh, like a lot of things we do in dentistry, there's a lot of managing expectations. And I think that's where, um, you know, the sort of the negative reports that you got from your patients come through. So I think one of those first things are the buttons or the attachments, um, that needs to

[00:12:13] be explained to the patient, you know, sort of in the consult, cause we've had that happen before. Like nobody told me that you were going to bond these things to my teeth when we did, but, um, so that sort of needs to be managed. And, you know, a really simple way of saying that is that, you know, just like, uh, traditional, uh, braces, you have brackets on your teeth. These attachments help to move your teeth.

[00:12:39] Um, they're going to be the same color as your teeth. And yeah, it might feel a little funny at first, but people get used to them over time. Hey, it's Kate, the assistant. And it's time to get very clinical in this episode of the very clinical corner. Dr. Mead, as a dentist, do you really know about your sterilization center? Uh, sink, autoclaves, there's instruments. My team seems to spend a lot of time in there. Right. Most dentists avoid that space, but here's the thing.

[00:13:07] A poorly designed sterilization area affects the whole practice. It needs four distinct zones, receiving, packing, sterilizing, and then storage. Storage? Yes. And it's usually the most neglected. Without enough storage, your team ends up compromising their sterile protocols by storing clean instruments above dirty areas, which is a huge cross-contamination risk. We also have a lot of materials scattered everywhere. Another consequence.

[00:13:36] Poor storage leads to chaotic inventory management. Your team wastes so much time hunting for things, and that means missing items, unnecessary orders, and more headaches. So the right sterilization storage actually simplifies inventory and keeps us compliant? Absolutely. Absolutely. And saves you time and money. Check the show notes for links to upscale your team.

[00:14:01] So I think that always expressing the positive. These are going to help move your teeth. You know, comparing it to something else that they know of, you know, like I talked about with the brackets. I think that, you know, that's an objection to get over. Another one is, you know, explaining IPR.

[00:14:26] So one of the things I don't like to say to patients is the word IPR because that means something to all of us, but it doesn't mean anything to them. And if you said, you know, interproximal reduction to them, that doesn't mean anything either. So we call that slenderizing. Oh, fancy. And so, yeah. So we're going to slenderize your teeth.

[00:14:51] And, you know, real simple explanation for that is we have to make some – if it's a crowding case, we need to make some space in between your teeth to allow your teeth to move. They won't move otherwise properly. And this will just, you know, speed up the final result. Can I stop you real quick, Kevin? Yeah. What percentage of cases need buttons? All? Most? Most. All. I would say all. All? To do it properly. All. Yeah.

[00:15:21] What percentage of cases need slenderizing, if you will? Nearly all. Okay. I mean – So this is every case. 90%. 90%. Okay. So so many – you know, I guess it'd have to be a space case otherwise. Yeah. So if it's a diastoma closure, probably not. But you can run into a problem with black triangles if you don't slenderize those spacing cases. Sometimes they need to be slenderized at the end.

[00:15:49] So those are sort of objections or I would say that was is playing prevent on those things. Do you have some type of a model showing the buttons or like a YouTube showing what slenderizing looks like so that people know what they're buying or not really?

[00:16:11] We have a model in each operatory of an Invisalign model basically that has the attachments on them. But one of the – like I saw it happen today. We started two Invisalign cases today. But the last patient is someone that I've known for a long time. Long story. But she stopped coming to us for a while and then she came back.

[00:16:37] And anyway, I saw – the best way to explain that is to have someone in your office in Invisalign. And one of our front office people, I saw her take out her Invisalign and show this patient her attachments. So – Yeah. Okay. You know, and that works out great. Okay.

[00:17:02] So then some of the other – you know, we usually have people – our habit is to not do slenderizing at the first appointment. Okay. Because that's irreversible and very occasionally it's happened once someone didn't want to go through treatment. And I feel like if we've done something reversible after the – we normally have a back in two weeks to do their first round of slenderizing, first round of IPR.

[00:17:32] And so, you know, if someone says, this isn't for me or whatever, that's a whole other conversation that we probably shouldn't get into right now. But – Sure. You know, it's only happened once. But, you know, normally at that visit, we'll say, hey, how did your first two weeks go? And most people will say, oh, my teeth are really sore. But, you know, I'm getting used to it.

[00:18:01] And then they'll say something like, wow, this has really put a hamper on my snacking. I'm going to lose some weight or something like that. So whatever they say, we – I mean, those are the three most common things that people say. And we have like a comeback, a positive comeback to all of those. Oh, your teeth are a little sore. That won't happen as much as we move on with treatment. Your teeth are just getting loose right now.

[00:18:27] You know, your trays are always going to feel a little tight when we put in a new one. But, you know, you're getting through the worst of it now. The losing weight thing, we kind of laugh at that. Yeah, you know, we're going to slenderize your teeth and you're going to get slender too or something like that. Yeah. And, you know, we just try to spin everything into a positive mode at that point. Yeah.

[00:18:58] Okay. We'll keep going. So I think that another hurdle can be when you get to the end of treatment and things aren't exactly, you know, what you thought they were going to be. And I think this is where you really need to have some – you really need to have some verbal skills. So we'll divide into three categories maybe.

[00:19:29] If there's a fourth on the fly, then listeners and you will forgive me. Okay. So category one is everything looks great. I think it looks great. They think it looks great. And we're talking about the very end. We're done. You know, we're going to order your retainers. And next visit, we'll take off your buttons and take some photos and get you in your retainers. Yay. Everything's good.

[00:19:54] Category two is things didn't quite move the way we thought they were going to move. And we're going to need some – to do some refinements. So at that visit, I will usually say something like, oh, you got a little bit of a straggler there. We're going to need to make you some more trays to get everything to move. And you might get a reaction like, oh, more trays. Do I have to pay for that? No, that's all included in the cost. You know, that's an easy deflection right there. Right.

[00:20:23] Or more trays, how many more? How much longer is this going to take? And quite frankly, I don't know the answer to that. So I'll sort of deflect that. And I'll say something like, I want to do the very best for you. You paid a lot of money for this. I want it to look right. I want you to be happy and I want me to be happy. Oh, okay. That sort of thing. And this is something I've thought about a lot.

[00:20:50] There's no way we could do the amount of Invisalign we do if we still had to take physical impressions. Because trying to convince someone to do a refinement and take the kind of impression that we used to take, we would get a lot of resistance to that. The scanning, no one really, no one says, oh, that's so gross. Sure.

[00:21:17] You know, that has eliminated that sort of negative reaction out of the practice in terms of that. Um, then the, another reaction you can get is how do you, uh, how do you like the way everything looks? Um, I'm ready to be done. So, what that may mean is to my standard or your standard, Zach, or any other dinosaur, it's not done.

[00:21:48] But if they're an adult and they've paid for it and they want to be done, they're done. I, you know, I'm not going to fight that. Um, you know, I've learned that. Like maybe they may, maybe they came from like looking like a D and they're at a, they're at a B and. Correct. And, and, and that's good enough. And it's usually an upper lateral. They're usually stragglers that didn't turn the way you wanted it to. Or maybe there's a lower incisor that needed to be extruded or intruded or whatever. It just doesn't look right.

[00:22:17] It's not perfect. I don't care. If they say they were done, they're done. Gotcha. Is the, is that, is that person generally somewhat satisfied? Mostly sad? I might feel like one of those surveys. I think they're mostly satisfied. Do you feel? I think they're mostly satisfied. That's funny. I think they're mostly satisfied. Um, and for whatever reason, you know, it, uh, it, if it's a burden on them, then, you know, that's fine.

[00:22:47] I, I don't, I don't hold any. You're not going to fight it. You're just not going to post the result. Right. I'm not, you're not going to see that on very clinical Facebook group, which you should do. Yeah. And there's plenty of those that I don't post because I don't like the way they look, but they're ready to be done. And that might, I mean, if you're an orthodontist out there and you think that's heresy, I, you know, whatever they, it's, they paid for it. Right. They want to be done. They're done. Sure.

[00:23:13] Well, and, and odds are in the majority of those, if you were to post them like, you know, privately to us or something like that, I'm guessing that maybe a non-dentist, uh, would look at the person and be like, Hey, you look, you look better. Yeah. You know? Yeah. It's, it's an improvement. It's not perfect. Right.

[00:23:32] It's almost like someone maybe who's going on a fitness or weight loss journey and, you know, maybe they didn't go all the way to like, you know, looking like a, you know, 10% body fat men's health guy, but, but they look a hell of a lot better, you know? 100%. So, yeah. Okay. The last category is, you know, that percentage of people that are truly never going to be satisfied.

[00:23:55] And what I'm talking about there is it looks done to me, but they want their lateral incisor turned 0.0001 microns rotated or, you know, a lot of thing that a lot of what fools people are the shapes of their teeth, which we have to sort of intervene in that early. In other words, they've had a lot of incisal wear because they're deep bite and now we've unraveled all that. You can see all that.

[00:24:21] So, you know, we're much better at cautioning them at the beginning. We're going to need to do some bonding or maybe some veneers at the end, but we're going to get everything into the right place. And it's hard sometimes for them to see through that because we're used to looking at that, but they're not. And sometimes, you know, just doing... You're right though. Some, some people's teeth just don't have good, good shape. It's a tooth shape problem. Yeah. Even though we've put them in the right place. And sure.

[00:24:51] You know, there's several cases that I can think of and it, sometimes all it takes is some manicuring of the edges or small bonding. And it, it completely changes the case. It's like literally putting icing on the cake. Yeah. Okay. There are still some of those people that aren't completely satisfied and that is where it becomes difficult. And I think I said, I don't know, 10% or whatever when we were right. I think it's probably less than that, but there are, those are the ones that you're going to remember.

[00:25:21] Yeah, for sure. And so early on, I, you know, I was more defiant or not agreeable. And, you know, like we're done. I can't do any better than this. And I think that that is the wrong approach. Um, I think the approach is, yeah, let's make you some more refinement aligners.

[00:25:46] And, um, I, you know, I will literally keep doing that until they're done. And so my analogy to that at some point, I have to pay for those, you know, you get, you know, uh, there's different. You have to pay for them or they have to pay? I have to pay for them. Yeah. Okay. Right. There's another category that's going to come up that I thought of. But anyway, um, uh, depending on what level Invisalign product you're using, you may have to pay for them.

[00:26:14] And I, my, I liken that to, I know I've used this analogy before. Um, if you, Zach, need to do a crown on number five and some, on someone that can open like as wide as the Grand Canyon and is completely pleasant and loves you to death. And is the most pleasant person to be around versus doing a crown on number 15 on someone who's gagging and has to go to the bathroom every five minutes and can't swallow or just spit. And you're charging the same amount for both of those. Sure.

[00:26:44] Every once in a while I get burned by the endless refinement person. And that's just the way the game is played. It's not a high percentage of them, but, um. So would you consider just cost doing business? Like some people are just going to. It's the cost of doing business. And it's also, um, my Invisalign manager, Rita, and I really trying to figure out what it is that you're seeing.

[00:27:10] Cause sometimes what we're seeing and what they're seeing isn't the same. Yep. Or what they're feeling. So this happened, uh, I think yesterday, uh, someone said they'll run their tongue along the backs of their teeth, even though. So, so the, your teeth are different thicknesses. Sure. So if they're lined up, just because you run your teeth along the backside of them doesn't mean that they're not lined up. It just means that maybe your lateral incisor is a little thicker than the central incisor.

[00:27:40] So we sort of have to, enough of this has happened over time where we can very quickly, you know, explain, you know, kindly and gently, you know, that, that's not something that we're able to fix. Um, but anyway, those are the ones that, um, you need to, you know, use a lot more verbal care with.

[00:28:02] However, I did have this thought today and I think someone else in our, our group may have said this, but I have a denture patient that, um, you know, is not satisfied with the way her denture looks. Sure. Uh, currently. And my thought is your teeth were super fricking ugly. Yeah.

[00:28:31] Before they were extracted, you never took care of them. Um, and I've given you what anyone would look at as a beautiful smile. And you're complaining about one tooth on the denture needing to be rotated. Like, what are you looking at? You know, what, what is going on in your mind? And, you know, you can't really say that. Well, I can't say that to someone. I just don't have the balls for that.

[00:28:56] But it's like, it, it, it blows my mind that a denture patient in particular would complain about the way something looks when you know how that looked before. Sure. Horrible. Horrible. So, um, those same sort of skills. I mean, you're basically lining teeth up within this line is kind of the same thing.

[00:29:17] Um, but, uh, maybe a little bit of a different mindset because these people are more, uh, care more about their teeth. I do think that sometimes the ortho patients get hyper-focused on their teeth. And that's where that's coming from. You know, I need, I need this 0.01 rotation or whatever it is.

[00:29:38] And, you know, sometimes you just gotta, you know, after several refinements, then, you know, you kind of get to, that is the best we're going to be able to do. But I'm better at sliding that in. That's what she said at that point of the conversation. There is one other category and that's a patient who's clearly not wearing their trays and their teeth aren't moving. Oh, yeah. You said the person who just leaves, never comes back.

[00:30:05] Those are the people that flake, which that's a low percentage really. But there are, you know, people who clearly aren't wearing their trays. And so I guess they divide into two categories. One, they're not wearing their trays and they admit it. And, you know, the only thing I can do is, like, my joke always is at their first appointment, these trays don't work if you put them in your pocket. They have to be in your mouth. And at the initial appointment, everyone was like, ha, ha, ha, ha, ha.

[00:30:34] But then, you know, four months later, when things aren't tracking or whatever, like, that's on them. You know, so we'll have some sort of a heart-to-heart at that point. And most people will admit it to a certain degree. There's another percentage that will flat out lie to you. And, I mean, I'm not really good at dealing with psychopaths. So, you know, if you're going to lie to me, I'm just going to sort of play the game too and we'll get you to some sort of an end point. And that's the best it's going to be. You know what I mean?

[00:31:05] So, do you – But I think that from our conversation – How often do you kind of, like, identify these people in advance just based on the consult and how – and if they've been a patient for a while, if you know them? Or do these people kind of sometimes surprise you? Like, oh, all of a sudden now you're going to be the hyper-picking person? Yeah. I think that overall, I think that our conversation, like, tended to the negative because that's what everyone remembers.

[00:31:31] And the people that talk to you, of course – like, you know, if you said you had to go get your vasectomy or your appendix out, almost everyone's going to have some sort of a negative story about that. No one's going to say, oh, yeah, they – you know, I didn't feel a thing and it was the greatest thing ever and they gave me a lollipop or whatever. No one's going to say that. So we tend to be dramatic about things because it's more fun.

[00:32:01] And I think that was the feedback you were getting. Out of all what I just talked about, the majority of people are satisfied and happy that they did it. It's just, you know, you've got some of these people just like, you know, you did a crown on someone and, you know, they're – You know, it's too fat or it made their toe hurt or their – Sure. Your grandma died the next day and they blame you for the crown. It's just sort of human nature. I mean, if we insert 100 crowns – Yeah.

[00:32:31] I don't remember the 90 where I never heard a call back and the next time I see them at recall, I ask them how their crown feels and they're like, oh, it felt amazing immediately. I remember the four adjustment person. Right. You know, or the, you know, this has never felt right, you know, or what's this line at the bottom of this on my second molar? The four adjustment person is akin to the multiple refinement. Sure, it is. It's going to happen. Yes.

[00:33:01] I get that. And then the other thing about it is after doing this for a long enough time, like, we really hammer home the retainer part of it. We have them sign a contract. Okay. And then – and some – I mean, you've seen some of my cases. They're really nice. Yeah. And then some of those people come back on recall and I know they're not wearing their retainer. And guess what? Sure. I don't care. That's their problem. They paid for it. We told them everything that they need to do.

[00:33:29] If you're not going to wear your retainer, that's on you. And the other thing about that is a majority of people that we're doing Invisalign are adults that had ortho as a teenager and didn't wear their retainers. Sure. I mean, that is the same story. So, if you're that big of a loser that you can't follow instructions even as an adult, I get it when you're a teenager. I mean, we're all, you know, brain dead at that point.

[00:33:54] But if you paid for it yourself and you still don't want to wear your retainer, that's on you and I don't really care. Yeah. Sure. I've done the best I can. I can't come home to you or, you know, I can't go into your bathroom at night and put your retainer in for you. What? That's not a service that you're providing? We charge a little bit extra. That's Invisalign Plus. I don't even know what that is. It's probably a thing that you don't even know about yet. Or it's coming soon to a theater near you.

[00:34:24] There is something coming soon, but that's another story. Oh, ooh. Ooh. Yeah. But anyway, I don't think it's as big a deal as. Is the person that you're having like trouble satisfying? You're doing the extra. I almost hate to use this analogy, but sometimes you're like, you're going to wear the person. You're like wearing the person out. Like almost like. They're wearing me out, actually. Well, yes, they're wearing you out.

[00:34:52] But I mean, like you're just going to like, you're going to like wear almost like the, you know, the denture person that gets their 20 adjustments or whatever. Like, you know, but I mean, I don't know. Is there angle that they're really not happy? Is there angle? Are they trying to get some kind of a refund or something like that? That's never. Is it a money angle? I don't think that's ever. That. That's never happened where we've got to the end and I've refunded someone. That's never happened.

[00:35:21] The only thing that the only thing that's happened is when we introduced the IPR to the person, they're like, whoa, no one ever told me about that when we did. And I'm like, I don't want to do this. And then three years later, they wanted to do ortho again. And all of that was forgotten. And the case came out great.

[00:35:45] So I don't know what's, you know, this particular person, I know, you know, there was some mental instability there. And I think maybe she got that under control. So whatever. It came out great. She loves us. That's the other thing.

[00:36:05] You know, I'm really lucky to have a great Invisalign manager who becomes friends with these patients and then, you know, sees them through the whole process and becomes the point person for them. And so a lot of that. That's got to be extremely valuable person to have on multiple levels. It's deflected onto her.

[00:36:27] And I, you know, I will come in to sort of manage some expectations, but she's doing most of it. So that's all part of your, that's all part of your business model though. Like you're doing that as like, and I mean, what's, are you doing the IPR? I assume you do the IPR. Yeah, I have to do the IPR. Yeah. You do the IPR and you probably bond the buttons. And then I'm guessing there's probably, no, you don't even have to do, oh, you have an EFTA for that. Okay. All right. All right.

[00:36:57] Well, you've got a well-oiled machine, my man. I'm in, I've always, I'm always impressed. I'm always impressed. If you enjoyed hearing about the trials and tribulations of Invisalign, come join the Facebook page, aforementioned Facebook page. And Kevin's always on there to answer your Invisalign questions and concerns. So all that good stuff. Happy Thanksgiving. Yeah. Happy Thanksgiving. Kevin? Yeah. You have a great one.

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