Very Dental: A Recipe for Implant Dentistry Success with Dr. Tim Kosinski

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[00:01:30] This is a production of the Very Dental Podcast Network. This is the Very Dental Podcast. Welcome to the Very Dental Podcast, where you'll find entertaining and relevant conversations with visionaries, clinicians, and your friends in the dental space. Now, here's your host, Dr. Alan Mead.

[00:01:58] Very Dental people, welcome to another episode of the Very Dental Podcast. I'm sitting here in the illustrious Chicago Dental Society podcast lounge. This is Thursday, first day. I've been going all day, although not quite as much as my guest, Dr. Tim Kaczynski, who was lecturing all day. Tim, how are you doing? I'm doing great. Thanks for having me.

[00:02:21] So, this is cool, because Tim is a Michigan guy, and I was telling him he's one of the first continuing education speakers I ever saw out of dental school, because he was teaching. He came to the Saginaw Valley District, probably multiple times, but I mean, I remember vividly. And you were talking implants then, too. Right, way back when. And that was when implants were like, well, we'll just leave that to the specialist. So much has changed since then, obviously, but it's really nice to have you on in person. Thank you. I appreciate it.

[00:02:49] So, you lectured today at the Midwinter, and you're lecturing tomorrow. And your course is called, it sounded like a good topic, I thought we should talk about it. Yeah, Critical Thinking for Implant Dentistry, A Recipe for Success. Yeah, yeah, that's what we need. That's what we need. So, what kind of, I mean, you and I, you lit my fire when we were talking about, you know, just, I don't know, implants are in a weird place right now. I mean, talk about that a little bit. Tell me, I mean, we sort of started talking about it, but.

[00:03:18] Yeah, you know, it's changed a lot. You know, I've been doing implants for 39 years. We just passed our 20,000th implant that I placed. Oh, my gosh. Since 1984. Yeah. And you have to remember, our modern implants really were introduced by Brandenmark in 1982. So, I've been there since the inception. Sure. And I was blessed with tremendous mentors throughout my career. Yeah, yeah. And it's kind of blessed at this time to come and give back some of my experience and wisdom.

[00:03:48] Somebody said, experience and wisdom, what a great combination. And, you know, I like to tell my attendees, you know, the courses I'll sell out. And, you know, I'm giving them a gift, a recipe. I always tell them, you know, I make a really good implant chocolate cake. Yeah. And it's like excellent. Yeah. I'm going to give you my recipe. Like Martha Stewart. Yeah. And you can take that recipe and you're probably going to make it your own to some degree. And you may make a chocolate cake that's better than mine. But you need the foundation.

[00:04:13] A recipe is, honestly, it's tough in dentistry to, recipes are good. Like a prescriptive, like do this, then this, and this is why. That's a good thing for dentists, I think. That's the way I've always taught. That's how my brain works. It takes a lot of time to prepare every step.

[00:04:59] Mm-hmm. It's just, it's all relative. Yeah. You know, my first house was $49,500. I didn't know how I was going to ever pay for that. Mm-hmm. So it's all relative. I got out of dental school with $85,000 in debt. And at the time, I'm like, I'm never going to survive. Yeah. And now $85,000 is like not even freshman year in dental school. It's crazy. Yeah. Yeah. So, but that's okay because it's the best profession on the planet. Yeah. By far. It's very rewarding.

[00:05:27] And for those doctors who take the time to evolve and learn and don't sit on what they've just learned in dental school, continue education. I'm a big educator. I'm a big believer in education. The Academy of General Dentistry is so important to me. You know, I'm the editor. I'm an executive board. They're leaders in education, really high quality. The courses here are phenomenal, Chicago Midwinter, and phenomenal courses, great speakers, where there's so much to learn.

[00:05:58] Let's direct it towards the young people. You got to get out there and you have to come. No, you do. You can't learn it on YouTube and you can't learn it on Zoom meetings. And that's something they don't want to hear. Well, they have to hear it. I think you're right. And the other thing is, is that, you know... Okay. So my dad brought me to Midwinter for the first time. Well, I mean, I was coming here as a little kid because my dad would go on the train from Lansing. Dad would come to the meeting and my mom would take my sister and I like shopping and water

[00:06:26] tower place and all that stuff. So, I mean, like I kind of grew up coming to this meeting. And then when I was in dental school, he brought about 10 or 15 of my best friends from dental school. He got us hotel rooms and brought us to the meeting. So, and then I, you know, it's rare that I miss Chicago Midwinter. It is an exceptional meeting. I mean, like there's so much CE. And then more than that, there's so many other meetings going on at the same time with specialty stuff. So like you can hardly miss, but you do have to come. Like, like, I don't know.

[00:06:55] I wouldn't want to like participate in the meeting sitting at home watching a Zoom version of it. It's, I think the, I think the face-to-face is important. And I think between the culture of maybe younger dentists and then COVID, I think a lot of people have sort of, well, face-to-face, but I think it's a, tell me what you think. Face-to-face is really important. It's vital. You have to network because you don't know not one person sitting next to me at lunch or at a meeting or at a coffee shop, you have no idea how that person can affect the rest of your life. Sure.

[00:07:25] And, you know, my, my future associate, future partner is here. She's a third year at Chicago Midwestern. Look at you. That's good. And she, she kind of sponsored the class. She got up and she took the time. Um, it's, it's a great way to learn. I met her, I had my knee done four years ago and she was the therapist. She was the tech that was rubbing the leg with the massage. Yeah. She wanted to go to medical school and did poorly. I go, forget medical school. You need to go to dental school. That's the best profession in the world. Listen to you. That's, that's amazing. COVID hit.

[00:08:22] Yeah. I'm going to be a good time where really online stuff didn't, didn't really exist. Computers didn't exist. Yeah. I mean, like, I mean, that's. I'm still an AOL guy. I know. Right. Like when I was in dental school, I got my first email address at the university of Minnesota and you had to go to the computer lab to use it. So I mean, like I don't have anyone to email. What do I need an email for? Exactly. So I mean, I'm old enough to remember that, but now there's so much that's available and it's not, not to say that there's no value in that, but there's a lot of didactic.

[00:08:48] So I'm going to argue that like my DEA number thing that I had to go take eight hours for or whatever, that being online, I'm cool with it. Yeah. Because, because, yeah, but there's, you're not learning implants on YouTube. It's not going to work. Right. You know, there's a lot that you got to show up for. So I, and I feel it's cool that you say that. So, so you talked about this kind of thing at the midwinter, which is probably an exceptional meeting with a huge variety of stuff. What, how was the reception? A course was sold out.

[00:09:18] Just, you know, great, very interactive. Interesting. Okay. Which is really important because when, when people are interactive and it was a pretty big group, you know, um, it means I'm connecting with them because when they, when they voice their thoughts, 10 other people think the same thing and it's because they're missing something. Um, and so interacting and giving them that information is so critical and critical thinking.

[00:09:45] If everything goes well and putting, putting a spark plug in the jaw is not the hard part. It's not the hard part. It's the easiest part. Yeah. It's under, it's number one, communicating with the patient, getting them to pay you, doing the work, understanding anatomy and understanding when things go wrong. Yeah. And that's a big thing that is lost in the profession. Mentoring is kind of faded away. You know, you have a mentor that can, can help you show you direct you, um, uh, help you.

[00:10:12] I'd like to say, you know, when, when I was young, my mentor was Paul Mentag and he taught me early on visualize the case finished before you start. Okay. Took me 10 years to master that. Sure. Modern technology, all this stuff on the exhibit floor. Yeah. We're all equals. Yeah. They, they can do exactly what I do. They work with quality technicians. They can design things. The white is the white. I'm nothing special, but it's, it's creating the foundation for them to, for success. And that's what's lost.

[00:10:40] I feel like, you know, with implants, it's, it's always, well, treatment planning is kind of everything. Like treatment planning, you can do a lot in advance to make the, make the actual placement and restoration simpler and more straightforward because you understand the anatomy. You understand the potential complications before you ever get in there. I mean, 3D imaging has really made a big difference for that. I think maybe, maybe that's one of the bigger things. What do you think about all that? For when you're treatment planning, what are the things that, what are the things that you're telling people?

[00:11:10] Number one, we're talking personal now. So I think that number one, I deal with the patient's major concern as I first meet them. Yep. Okay. If they let me fillet them and put a spark plug in their jaw, they're going to let me do everything over time. Yeah. Yeah. We have to, we have to respect people's budget and time. Number one. Number two, yeah. Technology, CBCT analysis. I can virtually place the implant and the crown before I ever touch the patient.

[00:11:36] I can design, figure out what it's going to cost me and educate the patient on the benefits of what I can do for them and, and have them accept treatment. That's huge. Yep. Okay. Um, digital scanning, milling, printing, uh, AI is going to change dentistry remarkably, remarkably, but we, you and I are not technicians. We're diagnosticians. We're professionals.

[00:12:03] And we have to understand that there's a person sitting in the dial chair that we are doctors of the mouth. We are changing their quality of life and we can change their overall health dramatically. We are making a difference. It's just a great profession to have just a wonderful profession to be in right now. When you think about implants in a lot of cases are solving solve. I mean, okay. So there might be people that have had long-term dental space missing teeth, but in a lot of

[00:12:32] cases, you've got people that have teeth that are failing and they're literally walking around with, with low grade abscesses, low grade infection in their jaw or whatever. It doesn't hurt. And they don't really understand why it's there. But I mean, like literally, literally if you can move them into some kind of treatment to get that out of there, you literally are, you're changing their health. I mean, they, they say that some of those low grade abscesses are, are, are a huge problem with heart disease. There's like, there's a lot there and people, you know, you've seen it.

[00:13:00] People come in with teeth that are so broken down and so infected. They don't even know it because it doesn't hurt. Like it's wild to me that you're right. We could change everything with that stuff. You know, and, and, and that, and that's really, really true. And, and understanding, uh, um, saving teeth is important, but those that can't, and the patient, we have to provide options to the patients. Yeah. Uh, and I, legally, we, legal and ethically, we need to provide, uh, I'm going to give you an example.

[00:13:25] Um, uh, we're involved in a program called renew smiles and it was started by the person that, um, started clear choice 15 years ago. Yeah. And, um, it is a program that is pretty remarkable. It's over dentures, you know, it's, it's not permanent teeth that are easy to fix when things go wrong. Hell yeah. Um, but the patients that come in, I'll be very honest, they're, they're definitely a

[00:13:50] middle class clientele that come in and are so appreciative of what we're able to do. You know what the biggest comment I get from these people? Your office is so clean. It breaks your heart. Yeah. You know what, where, where are they getting treated now? Or maybe they're not. Yeah. And so giving back to your community, we can't forget that the money's great. The money's always going to come. I'm, I'm, I'm not a big, the debt thing. Yeah. And don't chase the dollar. Yeah. It's giving back to the community and that's what, why we're professionals.

[00:14:18] That's why we went in, you know, why do you want to be a dentist? Why do you want to be a dentist? I want to help people. Always. Yeah. That's classic. Everybody says classic. So yeah, we do want to help people, you know, and the financial rewards are immeasurable when you do the right thing for people. Yeah. Don't over-treat. There's a lot of over-treatment right now. Yeah. Yeah. Like, okay. So on some level, well, you said something that, that rings my bell because you're like, yeah, we need to save teeth that can be saved too.

[00:14:45] I mean, like, or the patient gets the option of course, but, but the reality is like, I think there, there's been a little bit of a pendulum swing to like people just like looking at teeth is just, I don't know. They, they look at it, they look at someone who's had some tough, some tough stuff with their teeth and they're just looking at a full arch implant case and that's just that. Take them out. I never want to see a dentist again. Yeah. Take all the, give me the, give me the teeth and I never want to see a dentist again. Yeah. Yeah. And that's, it's, I've been doing it too long. Yeah.

[00:15:13] You know, what you put in today isn't necessarily going to be there 10 years, 20, 30, 40 years away because they take really awesome care of stuff. And it's not like you can place implants in, in a, in a zirconia horseshoe and it's going to be perfect. I mean, like, I don't know. There's, I know people who do a lot of this stuff that are like, oh my gosh. And I know people who literally their, their office now is mostly revisions on these cases because of, because of the stuff that's going on.

[00:15:41] So like, yeah, there will be a backlash with the public. Yeah. There will be at some point. We can't over treat, respect people. There is, there is a process. There is a need, you know, but it's not every, you can't treat, you can't, you can't cookie cutter everybody into the same treatment. That's wrong. Um, for instance, you know, I'm, I was going to have our 50th high school reunion and I'm starting to see some of my classmates. Yeah, sure. All these, these old people are coming to say, no, I get it.

[00:16:09] And what, what, one of the friends came in and, and they were going to take all his teeth out, you know, to give them teeth in a day. Fine. And I go, Ron, uh, you're missing two teeth over here and one tooth over here. Are you not happy with your, your teeth? Cause they periodically, they were sound. They were just yellow, you know, a little chip maybe. He goes, no, that's me. And I go, well, you need two implants here. One implants here. If you want, if you want a Hollywood smile, I can do regular bridge. Yeah. We're not taking all your teeth out. Yeah. And you're right.

[00:16:35] I think the pendulum is swinging again, um, the other way because there, there's so many issues. So many people come in. If, if, if I knew you were going to, if, if I knew somebody, if, if they were going to do this to me, I never would have done this. Yeah. Yeah. Communication. Yeah. Communication. Make sure people understand what you're able to do. It's an incredible time to be a dentist. We're doing some incredible things. And it is, it is amazing what you can do with the, and the other thing is there are some people where that is, that is an excellent treatment. Yep.

[00:17:02] But I think, I think you need to let, it takes a lot of education to get that informed consent. Like how, how can you get informed consent from a person when you're taking their teeth out, but also taking a huge volume of alveolar bone. And they just, just because to make it work for that treatment plan, if that's your office, that's all you do on everyone. I'm just like, oh my God, that is like such a radical thing. And it, the patients have no idea that that's what's in bone. Bone is gold to us. It is. Of course it is. Yeah. It's gold.

[00:17:32] It's, it's wild. And I, I see it and I'm sorry. And it isn't to say that there's no place for it, but I know that it can't be the main thing for any other thing is every patient's different. You have to be able to understand their needs too. You know, it's, it's, it's interesting, but I mean, I feel like the sweet spot now for someone new is to learn how to place onesies, twosies, you know, replace teeth like, like implants were originally meant for, you know, like. We're, we're getting close to 20,000 implants. And I, I tell you, I agree with you.

[00:18:02] I'd rather put 10 singles in a full arch, like all day long. Yeah. You know, it's just like routine dentistry. It's where I started. It's 100%. The, the trick is for the general dentist, first off, and if you are a specialist, great, more power to you. Most people that I know and that are listening to this are probably in some kind of a, a general restorative practice.

[00:18:23] If you could make a, a single or two implants as commonplace as a crown prep, you are in, I mean, this profession is going to, it's going to make it for you really and truly. When you think about that. We do 80 to a hundred implants a month. That's a lot of implants. I work 13, 13 days a month. Yeah. And the need is, is unbelievable. Yeah. And I would rather do an implant than a deal composite on tooth number two, like all day long. No, I know. I know. I know. Like all day long.

[00:18:51] And that's the thing for someone, your patients want it. Yeah, they do. They're coming to you wanting this. Yeah, they do. But I mean, and I know a lot of people are talking about it like, that's the trick. The trick is to make it as predictable as the other bread and butter dentistry that's in your practice already. So tell me, how do you do that? How do you, when someone comes to a class for you or works with you, what are some of the things that you can do to make that predictable and, and, and normal for them? And that's again, going back to the recipe for success, the, the being aware of what you

[00:19:21] have to deal with. Number one, technology makes us all equal. We can, we can virtually design everything if we need to. So you have to invest in tech. Now I have a good friend in Pensacola that I work with a lot. She invested $200,000 and she had a very successful restorative practice. Beautiful. But she generated $1.2 million of additional revenue in three years because of that. That's a, that's a good investment and it's fun and her patients appreciate it. But you're not going to do every case.

[00:19:50] I think that's the problem that we don't realize. I tell my, my, my attendees, you can do six out of 10 that you see. You can't do every case. You got to feel comfortable in your wheelhouse. I think people don't want to hear that. I also think that there's. Well, they're hearing it now. Yeah. Good. Yeah. I mean, if you're in Chicago, you'll happen to hear, but like for instance, okay, I don't do a ton of upper molar endo. I don't do a ton of it. I have, I'm getting to do more of it. I had a case. Oh man, the guy came in and he was sore and he was swollen and I got the thing open and

[00:20:19] it had volumes of pus coming out of it. And I'm like, okay, this is satisfying. I don't know if it's going to be the end all for this tooth, but so I, I instrumented it. I mean, I didn't think it was ever going to stop leaking. I got it to dry. I put a little, I put some calcium hydroxide in it and, and I actually extruded some out. It was crazy. By the time I got the rubber dam off, I had some coming out of the fistula. I had, I mean, this guy had some calcium hydroxide and I'm like, oh man, you know, he came back for a recall. It looks awesome. It looks awesome. Treatment like that.

[00:20:48] And the guy's like, oh, it felt great the next day. It was fantastic. I mean, you figure he's walking around with a bunch of pus in his head. It's like, and you're like, okay, I could do that one. But I'm, that was the first molar. And it was, it was already, and you could see all the canals on the, I mean, case selection, right? I'm not doing the second molar with, with calcified canals. Screw that. That's why endodontists exist, right? Right. So you're, I love your point. You're not going to do all these. Maybe if you decide implants are all you do, but geez, when you're starting, you're not going to do all that.

[00:21:18] It doesn't, it doesn't matter. I do a lot, as many as anybody in the country, I think. Can you still send some out? I work with my oral surgeon every week. Oh, nice. I know, I know what I do really well and what's financially rewarding. And so I can sleep at night. Yeah. But I know what other people do better. Yeah. You do a lot of them. You get really good. Yeah. You get really good. Today, docs, jump in with both feet, but you got to do 10 posteriors before you're going to feel comfortable. Yeah. Don't be jumping around. Yeah. 10 singles. Slam dunks where you got a lot of bone. Mm-hmm. Get really, really comfortable.

[00:21:48] Easy patient management. Yeah. Healthy. Yeah, exactly. Patients that are paying you and you'll be very, very successful with them. You know, I look at young people in the audience and I envy them incredibly. What a great life, the potential life that they have. Mm-hmm. If they're ethical, if they keep learning, keep learning. Are you AGD? I am. I am. So, you know, AGD has credentials, fellowship, mastership, lifelong learning. Uh, 500 hours, 150 are hands-on. Mm-hmm.

[00:22:18] Take a test. 500 hours, 150. Each lifelong learning, 500 hours, 150, community service in certain categories. I'm getting my fourth lifelong learning. Nice. In Montreal. It's because I'm always learning. I can always get better at better at what I do. I'm never stagnated. Um, learn, evolve, get better. Do you have to do hands-on pedo? Uh, you, well, you get, you get, you have to do eight categories. I know. I remember that. Everyone always talks about free AGD. Oh, pedo is so hard to get for this stuff.

[00:22:48] And I laugh. I'm like a guy who places 80 implants a month. I'd love to see you work on a pedo type it on. That'd be awesome. Yeah. Great. I love it. That's very cool. Very cool. So learn, keep learning. Mm-hmm. That's how you get better and make mistakes. Yep. But learn from mentors. Learn from people that have made all the mistakes. Mm-hmm. I tell them today, my failures because I put the implant too far facial. Mm-hmm. So I'm going to show you how not to put the implant too far facial. Yeah. Why should you do that? Mm-hmm.

[00:23:15] You know, the problems you've seen where the implants are all over the place and you have to restore it. I'm going to teach you, you're not going to be capable of doing that unless you really try. Mm-hmm. You know, that's the recipe for success. Yeah, absolutely. But you got to think first. It's not a rush. It's thinking about the end result. All that matters is the end. All the patients see is the, is the, is the white. There's a tooth. Yep. They don't see what's underneath it. No, that's right. That's right. That's fair. That's awesome.

[00:23:38] So now you, I mean, Kurt from Golden Dent has kind of hooked us up and, and last time you were on, we talked about a particular graft material and we got so much feedback and I'm, I'm dying. I'm blanking about the name. Osteogen. Osteogen, yes. Yep. And, and we got so much feedback from, from that and people, like we're all, all in on it and stuff like that. What are some, for people who are implant placers, what, what tips do you have that they should be looking for stuff like that? That's a good question.

[00:24:07] We got to, we got to give Golden Dent a little love here because they, because they got us together. Yeah. I will. And so in my practice, I've used everything over the years, right? Sure. You have to remember, I started with plastic Paris, glass beads, hydroxyapatite, trichin, nothing really worked. Yeah. I have two grafts in my office and one membrane. Yep. I use an allograft from Newport Biologics. I use a three to four month resorbable collagen membrane. Okay. That's very high quality. And I use Osteogen plug. Okay. Okay.

[00:24:37] From, from Goldent or Implident. And Osteogen is a calcium appetite in a bovine Achilles tendon matrix. We call it a synthetic material. I've used it for 15 years. I can teach, which is a general dentist in Detroit. I can teach you how to grow bone a hundred percent of the time. Pretty bold statement. Yeah, it is. If you have a socket intact, we're going to use this plug. If you have a facial wall missing, I'll use allograft and a membrane. Allograft, you always have to protect the graft from invagination of epithelium. Yep. Yep. Osteogen, you don't need a membrane. Okay.

[00:25:07] And it's a 40 or $50 plug. So you can build bone. Yeah. You will build bone in three to four months and objectively determine the amount of bone you have radiographically in three to four months. That's cool. Implant dentistry is the most financially rewarding thing we do in dentistry. Implant abutment and crown. Profit margin on that is the, is the best and your patients want you to do it. But you, we have to set the foundation. Yeah. If you take a tooth out, you have to build bone in that area or it'll shrink. And why aren't people doing implants?

[00:25:36] The posterior mandible, they're worried about the mandibular nerve. Posterior maxilla, they're worried about the sinuses. So you take a tooth out, build the bone so you don't have to deal with that. Patients won't pay for it. Well, if they don't and they want an implant later, it might be a much more invasive, expensive surgical procedure for them. Explain that to them ahead of time. And what you charge for the graft, if it's $40 plug. Yeah. You can, you got some flexibility there. You have some flexibility there.

[00:26:04] You don't have to overcharge and create the foundation to idealize the cases. So for someone who, I know there's a lot of people that like, oh, you know, if you graduated from the University of Minnesota in 1997, like me, didn't know much about this stuff. They probably just shuck a bunch of teeth and let it heal in. What would you tell that 1997 grad who probably knows better now, but why, why grab, why do socket preservation even if you're not sure you're going to do an implant?

[00:26:31] Well, bone is going to shrink down and in and lower jaw, up and in in the upper jaw. The sinus floor is going to collapse. If you remove the tent pole, that's holding it, the tooth that's holding it. And, and bone is gold to us. So maintaining bone. We've all seen those cases. Even conventional dentistry, we get the big concavity, the horse's saddle. And it doesn't look right. You know, it doesn't look right. So getting in the habit, I take a tooth out, it's going to be grafted, period. You know, and explain to the patient, don't overcharge for it.

[00:26:59] And communication, communication is not me talking to you, Mr. and Mrs. Patient. It's what do you want? What do you expect? Making them part of the process, making them understand how important this is. My job is not to sell you dentistry. My job is to educate, instruct you and make you help them, help you make the decision that's right for you. Not what's right for my pocketbook. And once you get that, that mindset, you're going to be very successful because people appreciate that. Yeah, for sure.

[00:27:28] What's the process with that, with that, uh, for someone who's, I mean, one of the things is that a lot of people are like, well, I'm not, you know, the most surgically adept person in the world, but I feel like a socket, a socket graft or, or socket preservation would make a lot of sense in my practice. What's the best way for someone to figure out how to do that? Well, take a course. We do webinars. We do live courses. Golden has live courses in Detroit, in Detroit, you know, and live patients. They bring patients in.

[00:27:57] First, we have to learn how to atraumatically extract. Yeah, yeah. Big deal. It's a huge deal. We coined that term about 10 years ago and dentists are weird. I was criticized so much. Atraumatic, meaning save the bone. Yeah, yeah, yeah. Okay. Make it, make the procedure easy on the patient. We use something called a physics forcep from Golden. Yeah. A set of four instruments. They're not expensive. Upper right, upper anterior, upper left, lower universal. And I'm able to remove teeth without putting pressure on the teeth. I don't break root tips.

[00:28:27] It's, I wouldn't work without it. It's the most magical instrument I've ever used. And we can take teeth out, again, atraumatically to the bone, to the patient, and to my body. I can save my hands, my back, my shoulder. There's no squeezing. Do you guys do the, are there hands-on courses with those? They do hands-on courses in Detroit. In Detroit. Oh my God, that's awesome. Gold Dent, if you contact them, they do them several times a year. Okay. They have Dr. Nazarian's grafting and implant courses there too. Okay.

[00:28:56] On their patients, on live patients. Okay. It's pretty amazing what they've done. See, I live in Michigan, you see. And it's a two-hour drive for me to go to Detroit. And it's pretty appealing. Yeah. That's pretty cool. Awesome. Kurt, we'll talk. That's really, that's really neat. I didn't realize that you guys offered the hands-on in Michigan. And like, that's very cool. That's awesome. And for those who come from out of state, you don't have to be licensed. The airport is 20 minutes away from the four-star hotel they put you in. Detroit is a booming city. Yeah. Very dynamic, very exciting, very safe.

[00:29:26] So come and join us. That's really cool. That's really cool. Okay. So you can help people learn how to preserve the socket. What else you got going down there? I know Dr. Nazarian does a lot of big case implant stuff. He's literally, okay, there's not a lot of places if you were going to send someone for comprehensive implant stuff around Saginaw. He's one of the guys. Yeah. You know, and I'm just curious, like what else, what else are they doing down there? Well, you know, you know, laser work, you know, grafting, the aesthetic dentistry.

[00:29:56] Yeah. You know, it's really in technology. Yeah. You know, it's two steps back. It's like doing a kitchen. It's two steps back before you get one step forward. Yep. So technology is great. You have to invest and you have to learn, learn how it works best for you because it changes from year to year. Yeah. It's really hard to keep up. It's really hard to keep up. So you have to work with quality people. Yeah. You have to work with quality labs, people that really care about your success. Yeah. And when you get into that mindset, it's pretty awesome what we're able to do. That's cool.

[00:30:25] That is great. Tim, this was fantastic. I would say we should do this again, but you've got, are you giving the same lecture tomorrow or is it a different one? A hands-on tomorrow. Oh, you've got the hands-on. Nice. Okay. So that's really cool. Good for you. Yeah. So people can come to Chicago and do a hands-on. Yeah. That's amazing. I didn't even realize that. Like, hands-on is hard to get sometimes. Glidewell Lab is sponsoring it. Nice. So they have, they're bringing all the equipment in. Oh, that's so good. You know, it's limited attendance, obviously. Sure, sure.

[00:30:52] But, you know, we get, we do a lecture and we get to work with the materials and you get to feel, feel it on models and then take stuff home. So that's pretty cool. That's very cool. Tim, this was fantastic. I'll be in touch. I'm very interested in, I have to tell you, I've gotten tired of flying. So being able to take courses down in Detroit is pretty appealing to a guy who practices in Saginaw. I'm just saying. That's very cool. Tim, this was great. I appreciate you. Thank you, Ellen.