Very Clinical: We've Changed Our Minds About Clinical Stuff

[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,

[00:00:21] we will entertain and amaze you with tips and tricks on regular daily dentistry.

[00:00:26] Here's Kevin and Zach.

[00:00:28] What is up Very Clinical listeners and welcome back to yet another episode of The Very Clinical Podcast.

[00:00:34] I am Zach Miners coming to you from Kansas City, Missouri

[00:00:38] With me as always, my trusty host, Dr. Kevin Hairfryer.

[00:00:42] Kevin, what's going on in Cleveland?

[00:00:44] The Indians slash Guardians are in first place and we won again tonight.

[00:00:47] So your Royals are in second place still.

[00:00:52] Hey, and we're winning tonight, too.

[00:00:53] You guys are on a heater. We're on a heater.

[00:00:56] When do they start playing each other?

[00:00:57] Yeah, I know. It seems like the way the divisions were lined up

[00:01:02] way back when that we played each other a lot, but hasn't happened yet.

[00:01:05] So whatever it'll be, there'll be plenty of matchups.

[00:01:10] I'm looking forward to it.

[00:01:11] So we brought on a multiple timer guest,

[00:01:16] our most expensive guest, Dr. Alan Mead.

[00:01:18] What's going on, man?

[00:01:20] A huge fan of sports ball here.

[00:01:23] You can come down to Cleveland and we'll go to an Indian slash Guardians game.

[00:01:27] I would I would 100% do that.

[00:01:29] And I don't love I don't love baseball, but baseball live is so fun

[00:01:33] because food and hot dogs and all that stuff.

[00:01:36] I we last week identify with Detroit Tigers.

[00:01:40] Yeah, I mean, I don't follow them at all.

[00:01:42] Honestly, we have a we have a minor league team in my town.

[00:01:45] So I when I go to baseball games, it's a loon's game because I can.

[00:01:49] I mean, it's literally I drive past it every day on the way to work.

[00:01:52] It's fun.

[00:01:53] You're losing the Detroit.

[00:01:55] They're Dodgers.

[00:01:56] They're they're they're Dodgers.

[00:01:58] Yeah, they're what?

[00:01:59] One of one of the meeting places in there is called Lasorda's Loft.

[00:02:04] They're all they're all Dodgers, and it is the friggin

[00:02:06] nicest stadium I've ever been in my entire life.

[00:02:08] It is nuts. Minor League Baseball is it's amazing how

[00:02:12] how that culture continues to I mean, they they do great.

[00:02:16] That's Americana.

[00:02:18] Yeah, it is.

[00:02:18] What is it, Alan?

[00:02:19] Is it single double?

[00:02:21] I don't know.

[00:02:22] Don't even know.

[00:02:22] All right. No, I'll find out.

[00:02:23] I'll Google. No worries.

[00:02:24] Maybe triple A. I don't know.

[00:02:26] Oh, OK. Wow.

[00:02:27] That's hot. That's big time. Nice.

[00:02:31] Kevin, why don't we why don't we

[00:02:33] use that as the bit and just get into it

[00:02:35] and we can do the other one next time?

[00:02:38] Let's go. Yeah, we talked about baseball.

[00:02:41] Yeah, baseball.

[00:02:42] All right. Yeah, baseball.

[00:02:43] They're they're the loons are the high a affiliate of the Los Angeles Dodgers.

[00:02:47] So does that single label?

[00:02:50] Interesting.

[00:02:51] So we're doing something a little different tonight, Kevin.

[00:02:53] Why don't you bring in the idea?

[00:02:56] So we were talking behind the scenes about

[00:03:00] dentistry and life in general.

[00:03:02] And we came up with this idea of things

[00:03:05] that we might change if we had the chance.

[00:03:10] And it's kind of bounce back between all of us in different forms.

[00:03:16] So what we're going to talk about is things that we would have changed clinically.

[00:03:20] That's going to be today's episode.

[00:03:23] And then next time, stuff that we would change business wise in our practice.

[00:03:29] And then the third thing will be what we would have changed in our life.

[00:03:33] So that's the big one.

[00:03:35] It's things it's things maybe that we do now that we didn't know then

[00:03:39] or things that we've changed our mind on over.

[00:03:42] Changed our mind on. Yes.

[00:03:43] Yeah. Yes. OK. OK.

[00:03:46] So in clinical dentistry, Alan, we'll put you in the the hot seat.

[00:03:49] What is a what is a clinical either, you know, a material, an idea, concept?

[00:03:56] What's something you've changed your mind on?

[00:03:57] Something you did it a certain way early on in your career.

[00:04:00] And you're like, you know what?

[00:04:02] That I got it. I got I got a good one.

[00:04:05] Kevin's probably going to be on board with this one, too, because we I don't know.

[00:04:08] Maybe you are, too, Zach.

[00:04:09] But in dental school,

[00:04:12] margins were meant to be subgingival in dental school.

[00:04:16] I remember that they I sort of learned that.

[00:04:21] You prep your margins a little just a millimeter sub G as the ideal. OK.

[00:04:27] And and of course, so then that you have to you had to be really good at packing cord.

[00:04:32] And of course, in dental school, I wasn't good at prepping.

[00:04:34] I wasn't good at packing.

[00:04:35] I wasn't good at stuff. So it was all ugly.

[00:04:37] But but then when you're dealing with subgingival, you're technically

[00:04:40] you're going to be dealing with more bleeding.

[00:04:41] Potentially, you're going to be dealing with more tissue beat up and stuff like that.

[00:04:45] And so over the years, I have found that I mean, obviously, if

[00:04:49] if the preparation dictates subgingival, I go subgingival.

[00:04:53] You know, that's obvious.

[00:04:54] But I my ideal is going to be equigingival if I can do it.

[00:04:58] And it really depends on the material.

[00:04:59] It depends on, you know, the kind of preparation I'm doing.

[00:05:02] I don't I don't do a ton of onlays.

[00:05:03] There was a time I tried to do a bunch of onlays, but I generally

[00:05:06] I generally do full coverage zirconia and with sort of minimal prep now

[00:05:11] and on my regular posterior units at this point.

[00:05:14] And of course, you know, that earlier on in my career, I didn't do that.

[00:05:18] I did a lot of porcelain, fused metal and stuff like that.

[00:05:20] But but the standard I feel like at University of Minnesota

[00:05:24] subgee was that's where you went.

[00:05:26] You wanted to bury your margins because you didn't want to show a metal margin

[00:05:30] if you could avoid it.

[00:05:31] And so you go subgee.

[00:05:33] And so and so I did that earlier on, and that's tougher.

[00:05:36] I think it's tougher to manage if you can keep

[00:05:39] you can keep an equigingival margin.

[00:05:41] Now, I don't know if you guys had that, but that's kind of how I started.

[00:05:45] I mean, you drop your margin subgee and you pack the hell out of it with cord

[00:05:48] and you get the best impression you can get that way.

[00:05:50] But, you know, there there are complications in subgee margins that that,

[00:05:55] you know, are, you know, if you if you don't have to do that,

[00:05:58] you sort of avoid some of that visualization and, you know,

[00:06:01] the kind of retraction you have to do and all that stuff.

[00:06:03] So something I have changed clinically over the years is I tend to

[00:06:08] you know, I avoid subgee whenever I can,

[00:06:10] and I'm going to keep it equigingival generally.

[00:06:12] And now that now that I'm scanning, I like that a lot because, you know, I mean.

[00:06:17] It's easier to, you know, retractions easier and all that sort of thing.

[00:06:20] So I changed my mind on where I, I mean, my,

[00:06:23] my goal for where I place my margins.

[00:06:26] Obviously you place your margins where you have to place your margins on some

[00:06:28] level, but it was just kind of, I think I sort of learned that in dental school.

[00:06:31] Kevin has his finger up.

[00:06:32] I have a comment. Yes. I know we like to

[00:06:38] make fun or sort of chide

[00:06:43] our dental hero, God, Bill Strub.

[00:06:47] Yeah.

[00:06:49] But way back in the day when I was a subscriber to his

[00:06:54] newsletter, there was a blurb in there about where to put your margin.

[00:06:58] And I would, I would say that I w I was taught the same thing in Ohio state at

[00:07:02] the Ohio state university. Yeah.

[00:07:05] What he said was to keep the margin out of the patient's biology.

[00:07:11] So while you were talking about that, that's what went through my head.

[00:07:15] Yeah. Is that stuck in my head more than, Oh yeah, that makes a lot of sense.

[00:07:20] And then the those newsletters were also talking about on lays and stuff that I

[00:07:26] got away from, but the premise is still the same.

[00:07:29] If I keep the margin out of the patient's biology,

[00:07:33] it tissue is going to be better.

[00:07:35] Definitely. So he would go so far as to do,

[00:07:39] he'd get his, his periodontist Danny Melker to,

[00:07:45] you know, like they, his favorite thing was, you know,

[00:07:47] although he always has exquisite cord packing, honestly, he's,

[00:07:50] his retraction is always amazing, but, but his margins are always,

[00:07:54] they're not, you know, it's rare that you see him bury a margin like that.

[00:07:58] So I get it. It's a good point.

[00:08:00] Well, you're going to say, I'm going to challenge you on this.

[00:08:02] I want to know if you changed your mind on it or did the material changes with

[00:08:08] time? You know, because Emax didn't come out until what?

[00:08:12] 2000.

[00:08:15] I never, and I never got, I never got into Emax either. I never.

[00:08:18] Whatever. Either way that you practice the first eight to 10 years of your

[00:08:23] career with, with PFM and gold dentistry.

[00:08:27] Yeah. And then, and then it was another couple of years of porcelain fused to

[00:08:30] zirconia, which,

[00:08:32] which you prepped kind of the same ways of porcelain fused to metal.

[00:08:35] But so did you change your mind or the materials allow you to,

[00:08:40] to do things in a different way that you hadn't before?

[00:08:42] Well, okay. So zirconia is a bit like gold, right? It can. And,

[00:08:47] and I mean,

[00:08:48] you wouldn't bother dropping a margin super low for gold unless you had to.

[00:08:52] Cause you know, it's not like you're trying to, it's not,

[00:08:54] it's not like you're trying to hide a metal margin.

[00:08:56] Gold's a whole different animal, but I did a ton of gold in the first 10 years.

[00:09:02] I did a lot of gold. So, uh, and it, you know, so yeah,

[00:09:07] actually that's a good point. Maybe the materials are such that,

[00:09:10] and I'm going to tell you that I, um, I mean, bonding crowns in,

[00:09:15] subgingival is a biggest mess ever. And I mind you,

[00:09:17] I don't do a lot of bonding of posterior crowns, but it's like, that's so,

[00:09:20] I don't know. That's a good point. A good question.

[00:09:24] Cause Kevin only bonds. Yeah. So, you know,

[00:09:28] it's not easy. I'm sure he fights that.

[00:09:30] No, but Kevin also knows that. I mean, you have to,

[00:09:33] you have to mind your mind, your biology and mind your mind,

[00:09:36] your crevicular fluid. I love that.

[00:09:39] Sometimes it ain't easy. Yeah, no, that's right. That's right.

[00:09:43] All right, Kevin, you're up. You're up next.

[00:09:44] What's something that you have changed your mind on?

[00:09:46] Mine, my two are going to be very closely related, but.

[00:09:50] Okay. Then go do both of them. Go back to back.

[00:09:52] I am going to say that what, well,

[00:09:55] first I'm going to say that what my mind changed on was that

[00:10:00] I was as a general dentist,

[00:10:04] placing implants was not my realm or that whatever

[00:10:09] the fear was. I know exactly what the fear was way back when,

[00:10:14] but changing my mind on that

[00:10:18] and learning how to do that safely and predictably

[00:10:23] and all of those things,

[00:10:26] that's something it took 25 years to change my

[00:10:30] mind on. And you know,

[00:10:34] now it's a big part of my practice and part of what,

[00:10:38] when I'm at 3d dentists and you have all these younger dentists there that are

[00:10:42] learning this for the first time,

[00:10:44] I'm jealous of them because I think it's a way for

[00:10:49] to really transform your practice and give you some financial

[00:10:54] freedom. You know,

[00:10:57] there's a whole lot of things that happen when you move your

[00:11:02] practice in that direction. So I wish I would have done that way sooner,

[00:11:06] way sooner.

[00:11:09] Would you go, would you go so far as to say, you know, specialty procedures,

[00:11:13] for instance,

[00:11:15] I've been thinking about this all night and I was going to say just specialty

[00:11:19] procedures in general,

[00:11:21] but that one specifically is moves the needle

[00:11:25] more than everything else. In my opinion,

[00:11:31] Alan, what you've, you've dabbled with implants, but it didn't stick.

[00:11:36] What's what's your, like,

[00:11:38] I didn't get a CT. That's, that's probably the main.

[00:11:43] Let me just say the second part. Now I should have got the combine

[00:11:47] five years before I did, there was way too much

[00:11:52] worrying about the cost.

[00:11:54] There was the comb beam and the implants and the transformation of my

[00:11:59] practice from 2016 on those,

[00:12:03] all those things are related. And I've told this story before,

[00:12:07] but I'll say it again. At one point,

[00:12:10] T-bone texted me and said,

[00:12:12] when are you going to buy the effing comb beam already?

[00:12:15] Just out of the blue, I was sitting on the couch watching TV and that's the text

[00:12:19] I got.

[00:12:21] That sounds like to ruin to me also.

[00:12:23] No context at all.

[00:12:26] No context.

[00:12:27] That was it.

[00:12:29] So getting the comb beam, you know, Zach,

[00:12:34] you really, you had this experience where.

[00:12:37] Yes. I'm loving it.

[00:12:38] Things, it just changes everything in terms of your

[00:12:43] diagnosis. One of the things I like to say in the,

[00:12:47] in the endo class of the implant class is

[00:12:52] if Missy tells me to go to the refrigerator and get ketchup,

[00:12:56] I will open the refrigerator door and it's a 2d plane to my male brain.

[00:13:01] Like I'll look in there, there, there's no ketchup. And then I'll say,

[00:13:06] Oh, there's no ketchup. And then she'll walk over,

[00:13:09] open the door and move stuff around in three dimensions.

[00:13:12] And it's right here behind in the middle.

[00:13:15] And yeah, right. So that,

[00:13:18] that is what the comb beam is to me. It's enabling me to,

[00:13:22] to see everything and why I dragged my feet and why I was hung up on the cost.

[00:13:26] And I'll, I know that those are valid concerns,

[00:13:30] but in reality they weren't.

[00:13:33] A technology like that, that you will use. I'll go. So, I mean,

[00:13:37] I know CT is a perfect example of it,

[00:13:39] but a technology like that that changes the way you do things. I mean,

[00:13:43] I will go so far as I'll say the intro scanner too. I mean,

[00:13:45] honestly technology like that, that first off, yeah, they're more expensive.

[00:13:49] Don't steal my topic.

[00:13:53] But, but it's, it, the payoff is, is worth it. And honestly,

[00:13:56] they don't always seems like, it always seems like it costs a lot.

[00:14:00] Like the cost is what sits, Oh my God. But, but I mean,

[00:14:03] you don't generally drop, you know,

[00:14:08] they'll finance it and you're writing it all off. And it's,

[00:14:10] it's a business expense that's,

[00:14:11] and you never even look back once you got it in there. You know,

[00:14:14] we talked about this over the past couple of days. I was in the shower.

[00:14:17] I'm like, it was just a payment. I got the return every month on one implant

[00:14:23] or one sleep case or whatever. All right. We're stealing Zach's.

[00:14:29] We know what you're going to say.

[00:14:30] You know what? I'm no, no, Kevin, do your second one.

[00:14:33] No, that was their book.

[00:14:36] Okay. You guys went, uh, well, Kevin, you went a little bigger. I was gonna,

[00:14:41] I was going to bring it down a little small.

[00:14:43] Actually I'm going to save what I was going to say.

[00:14:45] I'm going to say that for the second one here. Let me, I'll tell you this.

[00:14:49] Here's something I've changed my mind on. Uh,

[00:14:51] and I should have changed my mind on this within the first five years of

[00:14:54] practicing, but it took closer to 15 to get it right.

[00:14:58] I was taught the way I was taught in school. And then,

[00:15:01] and then my dad kind of reinforced that that training was that when you're taking

[00:15:05] out teeth, you know, you, you,

[00:15:09] you fight with all your elevators and forceps and all that.

[00:15:12] And the hand piece is the last option. That's like, Oh man,

[00:15:17] you're going to have to break out that hand piece. That's, that's,

[00:15:20] I can't believe it had to come to this. And you know,

[00:15:23] and I credit Kevin for a lot of this, but I've all,

[00:15:26] I also took some, some classes associates with associated with it.

[00:15:29] But now that's coming out, uh,

[00:15:34] much more often and much sooner in the process.

[00:15:38] And unless it's a perio situation or a single rooted tooth, um,

[00:15:43] it's at least going to be sitting out as, as, as something that's set up.

[00:15:47] It's not going to have to be like a, Oh great, get me the hand piece out.

[00:15:50] It's going to be like, I'm, there's a decent chance I might use this.

[00:15:53] And maybe I won't, if you know,

[00:15:55] I'm not quite as quick as Kevin to immediately section. I will at least give a,

[00:16:00] I'll give a cow horn a try or a few wiggles a try just to see if I don't have

[00:16:04] to use it because I'd rather not, but I'm very quick to,

[00:16:08] I worry very quick to cut in section.

[00:16:10] And the result has been more predictable extractions.

[00:16:14] Me willing,

[00:16:15] willing to take on more extractions and less trauma to the page.

[00:16:19] And I'm not even an implant place where I know you guys are trying to preserve

[00:16:22] the buckle plates for your, your implants.

[00:16:25] You're okay. But let's say you're not just, just for,

[00:16:28] just so I don't have to crank on the person as much, you know,

[00:16:32] they heal better if you don't freaking heal better.

[00:16:34] Like I am to the point where if it's a molar tooth and unless the,

[00:16:39] unless it's a lower molar with like super fused,

[00:16:42] sometimes upper most really fused roots where,

[00:16:44] where the hand piece isn't probably going to get you a huge advantage.

[00:16:47] I'm sectioning and I'm not, I'm sectioning like Kevin's I'm sectioning till I can,

[00:16:51] I can barely see the burr. And then honestly, what I really do,

[00:16:55] particularly on lower molars,

[00:16:56] I take a bite wing before I ever put an instrument on the tooth anymore.

[00:17:00] Cause I want to know the sectioning was dead on the money before I even put an

[00:17:03] instrument on it.

[00:17:04] Let me throw this out.

[00:17:05] If I can see it in three dimensions and know exactly where the roots are and

[00:17:10] go down through my axial view and like on an upper molar,

[00:17:14] when you know that the roots aren't fused or sometimes

[00:17:19] there's only a buckle and palatal route.

[00:17:22] Like the two buckle roots are fused.

[00:17:24] That's going to change where I'm in a section. So all of that.

[00:17:28] So I agree with you, Zach, when you said taking out the hand piece,

[00:17:33] I was like, Oh my God, that,

[00:17:36] that's how I felt like, Oh my God, we've, we've failed.

[00:17:39] And now it's the first thing I pick up. Like we're just going to,

[00:17:43] and I feel like my whole approach is like I'm dissecting

[00:17:48] the tooth and bone in a different way that I was ever taught.

[00:17:53] Atraumatic extraction start with a hand piece, correct?

[00:17:56] Yes, they do. And that's the quote of the night.

[00:18:00] Boy in dental school, like they wouldn't even give you the hand piece.

[00:18:04] And no, that's what I'm talking about.

[00:18:06] You were serious trouble. They had to get a hand piece out.

[00:18:09] Yeah, no, they didn't. They didn't do that for one. And um, like I said, then, uh,

[00:18:13] that I was doubled down on that and, and we didn't even have a,

[00:18:16] we didn't even have a regular hand piece or the right kind of hand piece to do

[00:18:20] it with. It was a whole thing. I mean,

[00:18:22] even on a case when I'm not going to section it like a premo or something like

[00:18:25] I still, sometimes we'll take out a hand piece and just do that slice thing in

[00:18:28] between the teeth just so that I have room.

[00:18:30] Yeah. Oh yeah. I'll use a regular or take off the crown or something like that.

[00:18:35] I just break the interproximal contacts if it's a premolar.

[00:18:40] Yeah. Way down in there and give yourself a nice fat spot to put an instrument in

[00:18:44] I call that the final IPR.

[00:18:46] Yeah. That's it.

[00:18:48] That IPR doesn't have to be nearly as precise as some of the other ones.

[00:18:51] You can use whatever fucking bird you got in your hand. Yeah.

[00:18:56] So I would say I've, I've changed my mind on,

[00:18:59] and I don't know how it's being taught dental school these days, but uh, God,

[00:19:04] you should be, you should have one,

[00:19:05] have one of those surgical hand pieces that has the,

[00:19:08] doesn't have the air shooting onto the tooth.

[00:19:10] And then two, like have the right birds and, and three, if you do that.

[00:19:15] And like I said, if that's being taught in dental schools now,

[00:19:17] and that's old hat cool, but that wasn't how it was taught to me, uh,

[00:19:21] or any of the people I went to school with. And, uh, uh,

[00:19:25] it's just something I just didn't,

[00:19:26] didn't know enough about and it held me back on extractions for well over a

[00:19:30] decade of my practicing life. For sure. Same here.

[00:19:33] Alan, what's your second thing you've changed your mind on?

[00:19:37] God, I've got, I've got a couple of them in there. They're hard,

[00:19:40] but um, I think you guys will probably agree with me. Um,

[00:19:45] you need to go to an indirect restoration more sooner than I used to.

[00:19:48] Like it's one of the things, and I still, I still struggle with that.

[00:19:52] I still struggle with that a lot, honestly. But,

[00:19:54] but the reality is is like what are the best fitting indirects you do,

[00:19:58] whether it's a crown or on there,

[00:19:59] they're the ones where you're not making a, like a Hail Mary safe, you know,

[00:20:03] in your, uh, I need to do that sooner than you think.

[00:20:07] And that's not to say that every tooth that walks in your door is a crown,

[00:20:11] but I'm just saying that like, you know what, if you've done,

[00:20:14] if there's been a decent size composite filling in there,

[00:20:17] in your replacing that you probably ought to go right to an indirect at that

[00:20:21] point. You know, there's, it's not every time, but in a lot of cases,

[00:20:24] and I struggle with that still, but you know,

[00:20:27] the ones that I feel the best about and I, the ones that I would,

[00:20:30] I would take a picture of and show the preparation to you are the ones where,

[00:20:34] where I'm not like,

[00:20:35] I'm not sure if I can make this work at all because it's so bad. Like,

[00:20:39] so I feel like I need to go to indirects sooner than I used to.

[00:20:43] Like, like, like the crown was,

[00:20:45] was at one point was kind of the last ditch effort, you know,

[00:20:49] like the last ditch restoration. Like, well, if you're doing that, you're making,

[00:20:52] all you're ever doing is making saves, you know, and you're just like, that's,

[00:20:55] it's not fun. And your results are not as good and all that stuff.

[00:20:59] So I feel like I've learned that I need to go to an indirect restoration sooner

[00:21:03] than I used to.

[00:21:05] I love that.

[00:21:06] I, yeah, I think Kevin would second that. And I would say I've,

[00:21:09] I would say I've come to, and I love

[00:21:14] most of your components. You're gonna be wrong, but I think.

[00:21:17] Let me bear my soul that back in the dental town days you had guys like

[00:21:22] Kanka and some of these other people that like, and nothing against them,

[00:21:26] but like they would, they made you feel bad about crowning it too.

[00:21:31] And,

[00:21:32] and so I guess my response to that is like,

[00:21:37] I've, I've said this analogy before. I can play guitar, but I'm not Eric Clapton.

[00:21:42] You know? So if you're an Eric Clapton of placing posterior composites,

[00:21:47] God bless you. But, um,

[00:21:50] I think overall I will side with our Lord and savior Bill

[00:21:55] Stroup on this. They're crappy. Like even the best ones I've done,

[00:21:59] I critics is all lasts at a long time or something.

[00:22:01] I see coming from other offices, they look like crap over time.

[00:22:05] And if I can't contour it properly or my after kept contour it

[00:22:10] properly. Uh, and certainly if it has an M O in it and there's decay on the

[00:22:14] distal, it's getting the crown. I'm not replacing a filling with a filling.

[00:22:18] This is not happening.

[00:22:20] So I think that's, I think that's, I think it's a smart move. It's,

[00:22:23] some days it's a harder pill for me to swallow and others,

[00:22:25] but I think it's probably the right move. Yeah.

[00:22:27] I've done way too many, you know,

[00:22:30] mega fillings where I didn't even give the person

[00:22:33] the opportunity.

[00:22:34] It was more just the, wow,

[00:22:36] I feel bad about recommending a crown.

[00:22:38] I've really done a better job.

[00:22:40] As recently as today.

[00:22:42] You just jogged my memory for episode two.

[00:22:45] Thank you.

[00:22:46] Oh, okay.

[00:22:47] All right.

[00:22:47] Thank you.

[00:22:48] Very good.

[00:22:49] Very good.

[00:22:50] Okay.

[00:22:51] All right.

[00:22:52] I guess I'll go with my second one here.

[00:22:52] I was between two, but I'm going to go with it.

[00:22:54] Of course, I think it's well documented on this podcast

[00:22:58] that I was, you know, very analog

[00:23:02] and almost kind of anti-digital in a way

[00:23:06] because it had been burned in me for so many years

[00:23:09] that like, ah, that stuff doesn't, you know,

[00:23:11] like CEREC generation one stuff.

[00:23:14] We'd see it come in.

[00:23:15] It looked bad.

[00:23:16] You know, you're like, ah, digital's not ready

[00:23:18] for prime time.

[00:23:20] And I think it took me seeing everything

[00:23:25] that Kevin posts and everything he talks about,

[00:23:26] talking to you, Alan,

[00:23:27] and seeing enough people having success with it

[00:23:30] to be like, well, if they can be successful with it,

[00:23:32] why not me?

[00:23:33] But it took you, Alan,

[00:23:35] letting me try out one of your, you know,

[00:23:37] scanners you'd retired.

[00:23:38] And I was like, oh, oh wow.

[00:23:41] You know?

[00:23:42] And you don't know what you don't know.

[00:23:43] And it's absolutely changed the way I practice

[00:23:47] and makes me look more modern

[00:23:49] and my assistants think it's cool.

[00:23:52] It's like, it's just a win in so many ways.

[00:23:55] And there's so much more I can do with it

[00:23:56] that I haven't unlocked yet.

[00:23:58] So, you know, I'm only on step one.

[00:24:02] I am too.

[00:24:04] And I will say that I still,

[00:24:07] I don't know if you guys feel this way,

[00:24:08] but I still, just in using it and I go in

[00:24:10] and I mark the margins and like,

[00:24:13] I think to myself, this is amazing technology.

[00:24:15] It's nuts.

[00:24:16] That stuff works at all.

[00:24:17] But like the analog, I mean, when you think about it,

[00:24:22] there's a lot less that can go wrong

[00:24:25] in a digital format than analog.

[00:24:26] When you go from an impression to a model,

[00:24:31] to wax, to metal or model and a scan and all,

[00:24:36] like there's a lot of things.

[00:24:37] And I always wondered in dental school,

[00:24:39] how does anything ever work at all?

[00:24:40] But with digital, man, you know, it's electrons, baby.

[00:24:45] There's no-

[00:24:46] So here's where we threw out,

[00:24:47] this is the third time I've brought him up,

[00:24:48] our Lord and Savior Bill Stroup,

[00:24:51] totally against digital,

[00:24:52] although I think they may have implemented

[00:24:53] a little bit now, but it's zeros and ones.

[00:24:57] It's digital data.

[00:24:59] It cannot distort.

[00:25:01] Yeah.

[00:25:02] All the things that you said, Alan,

[00:25:04] the wax, the stone, the impression material,

[00:25:07] it can't distort.

[00:25:08] And these scanners just are better and better.

[00:25:11] I'm using, like I scanned a denture case today.

[00:25:15] That's how we do everything now.

[00:25:16] It is the hub that our whole office revolves around.

[00:25:21] That said, you can do really crappy dentistry analog.

[00:25:25] You can do really amazing dentistry analog.

[00:25:27] You can do really crappy dentistry digitally

[00:25:29] and you can do amazing digital.

[00:25:31] It's just a tool.

[00:25:32] It is a tool.

[00:25:33] And I mean, like there are some days

[00:25:35] I wouldn't want you to see my scans

[00:25:37] and there's some days I'm gonna put them up on screen.

[00:25:39] But that's not it though.

[00:25:43] Do I think my margins fit a little bit better

[00:25:47] with the digital?

[00:25:47] I do, I really do.

[00:25:48] I do too.

[00:25:50] Do I all of a sudden look back at my analog work

[00:25:53] and I'm like, what was I doing for all those?

[00:25:54] No, it's not like that though.

[00:25:56] It's like my crowns fit.

[00:25:57] I took good impressions.

[00:25:58] I stand by the work that I did before I had the thing.

[00:26:03] What it unlocks is just a smoother patient experience.

[00:26:09] All of a sudden stuff like,

[00:26:11] instead of saving models for people,

[00:26:14] it's like I did a crown on 19 on someone

[00:26:18] and then a few months later, they broke 14.

[00:26:21] It was like, we already had that scan.

[00:26:23] That was in the system.

[00:26:24] It was like, hey, just clone this case.

[00:26:26] You've already got that scan.

[00:26:27] So now we just have to,

[00:26:28] hey, just scan the new crown we did

[00:26:30] and then we'll prep this up top one.

[00:26:31] It's like that kind of like data

[00:26:34] that's stored for you in the cloud.

[00:26:36] If you keep patients longer term,

[00:26:38] they're gonna get some benefits from that.

[00:26:40] Or if you've got that scan of them,

[00:26:42] they break a front tooth.

[00:26:44] You've got a copy of that.

[00:26:45] And if you're cool like Kevin and have a printer,

[00:26:48] boy, you really got a solution for a temporary

[00:26:50] or something for them real quick.

[00:26:51] I haven't gotten to that level.

[00:26:53] The other thing is though, is that the workflow

[00:26:56] is just hot sex.

[00:26:59] I mean, it's typical 45 minutes

[00:27:01] from literally when they're seated

[00:27:03] to when they leave with a provisional.

[00:27:05] And I mean, it's just because it's boom, boom, boom.

[00:27:08] And I mean, we've got our workflow

[00:27:11] particularly for single or two units down to a science.

[00:27:15] And I never felt like I had the same workflow

[00:27:17] in the analog.

[00:27:18] I'm the ones that you were talking about

[00:27:21] where you're proactive,

[00:27:22] the crowns that aren't a train wreck.

[00:27:25] Yep.

[00:27:25] That's the...

[00:27:27] It's the best appointment of the day.

[00:27:28] You can scan that in literally seconds.

[00:27:31] Yep.

[00:27:31] Yes.

[00:27:32] On the ones that are a little bit of a train wreck

[00:27:35] instead of taking an impression and waiting

[00:27:39] and then realizing you missed your margin.

[00:27:40] Oh God, it's the worst.

[00:27:42] Doing that over and over.

[00:27:43] You cut out a little, that little area

[00:27:45] and you scan it again.

[00:27:47] So it went from seconds to maybe a minute or two.

[00:27:51] And $20 in impression material.

[00:27:53] Yeah.

[00:27:54] When you think about it,

[00:27:55] even with a two and a half minutes set,

[00:27:57] you missed that first impression.

[00:27:58] And by the time you get it all cleaned up,

[00:28:00] you've wasted at least six or seven minutes.

[00:28:03] So now that you're on the other side of it.

[00:28:04] And if you miss it a second time, you know, huh?

[00:28:06] Now that you're on the other side of it

[00:28:08] and we made those arguments, whatever.

[00:28:10] Now you see that that is really, you know, that's true.

[00:28:13] Sure.

[00:28:14] Well, yeah, like missing a margin or you fixing a margin,

[00:28:19] fixing a reduction thing.

[00:28:20] Oh, the other day, I got done with my temporary.

[00:28:23] I was like, oh crap, there's a thin area.

[00:28:25] So, hey, crop this out

[00:28:27] and we're gonna just reduce it again real quick.

[00:28:29] Yep.

[00:28:29] Where's that option before with an impression?

[00:28:32] Is it now it's a, oh my God, I gotta repack this.

[00:28:35] Oh my God.

[00:28:36] Yeah.

[00:28:37] So yes, it's a smoothness thing more so

[00:28:40] that if you tell me your analog,

[00:28:41] I don't think you're doing bad dentistry.

[00:28:43] No.

[00:28:44] It's just that I think you can be doing it smoother.

[00:28:46] Yeah.

[00:28:46] And the workflow is the workflow is just.

[00:28:48] And still sexier like I would say.

[00:28:49] Yeah, it's definitely the best.

[00:28:51] All right.

[00:28:51] That's my thing and I'm glad I did it.

[00:28:53] All right.

[00:28:54] Any double downs, take backs, apologies?

[00:28:58] This was a good format.

[00:28:59] Yes.

[00:29:00] Okay, super.

[00:29:01] Can't wait till the next episode.

[00:29:03] Thank you guys for listening.

[00:29:05] It's gonna be the three of us again next week talking

[00:29:09] what things we've changed our mind on

[00:29:11] in terms of like business staffing.

[00:29:14] Staffing, yeah.

[00:29:14] That kind of stuff.

[00:29:15] Thank you guys for listening.

[00:29:16] Check out the Very Clinical Facebook page

[00:29:18] if you wanna hear more and we will see you next Tuesday.

[00:29:22] Bye.