Very Dental: Dr. Mark Whitefield on the Future of Full Arch Fixed!

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[00:00:55] 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. VeryDental people, welcome back to another episode of The Very Dental Podcast.

[00:01:11] I'm your host, Dr. Alan Mead, co-hosting today, this is the second time on the show, a guy by the name of Dr. Mark Whitefield. Mark, how are you doing? Good. Great, Al. How are you? I'm good.

[00:01:22] I was on the show a couple years ago, and what I remember about Mark was he hates removable. That's what I remember about Mark. Mark, am I right about that? Exactly. It's still the same, if not worse.

[00:01:33] Since I've talked to him, he's not decided that he loves removable. Still hates removable. It's one of the reasons that he was driven to be kind of an implant guy. He was pushed to implants because he hated removable.

[00:01:44] He wanted to be able to do better for his patients and not have them require removable. We did a podcast a couple years ago. I'll put a link in the show notes if you haven't heard it, because we talked a lot about this stuff.

[00:01:56] According to Mark, there's a lot of stuff we talked about back then that sort of ... There's been an evolution. He's got a lot he's going to tell me. I have made a point of not finding out all that much about what he's going to say.

[00:02:08] It's going to be as much of a surprise to me as it is to you. Mark, welcome back on the show. We're glad to have you. Cool. Thank you for having me back.

[00:02:16] Yeah, it was just kind of fun last time when we were just talking and yapping and really squawking about a lot of different things that drive us crazy in certain realms of the industry.

[00:02:30] To go back, it's really interesting to see how a lot of these things that we were talking about or problems, issues have really ... We've come up with some really good solutions for these and technology is really the driver across the board. Definitely. Okay.

[00:02:45] Tell me some of the problems. I don't know if we talked about full arch implants that much last time. I feel like that's kind of the direction you've gone into. I got to say, full arch implants is a ... I have a love-hate relationship with it because

[00:03:02] first off, I have a lot of patients that probably would benefit from it. I think a lot of dentists who are learning full arch ... This is politically incorrect, but guess what? It's my show.

[00:03:14] I have a lot of dentists that are learning full arch implants maybe are a little quick to go to full arch implants on patients because they've decided that the teeth aren't restorable or whatever.

[00:03:26] That's maybe a political thing, but the reality is a lot of people are moving to full arch implants because they are tired of being brokenhearted over patients that they attempt to restore that just slowly but surely.

[00:03:39] Honestly, it's a story of a lot of older patients where they just go downhill slowly but surely. It's like you're trying to stop the boulder from rolling down the hill and you can only stop it so slowly.

[00:03:53] But okay, I don't have many people that I feel comfortable and able to refer to for full arch implants around me. And frankly, it's the kind of ... The cost involved is typically more than a patient can put their brain around here.

[00:04:13] I won't lie to you, I've got two that I've gotten to ... God, this is amazing. Around me, and there's probably people who would say, well, I could do this around you, but they haven't made it aware.

[00:04:22] I've sent them to Clear Choice of all places and the closest Clear Choice is two hours south of me in Metro Detroit. And the patients are pretty happy about what's happened there. In other words, these are patients who had been long frustrated with teeth that were

[00:04:35] just failing and I didn't have many solutions for them. These are a few patients, not a lot of patients because the amount of money involved in the ... These are patients that financed it and they decided it was worth the payment over a long period of time.

[00:04:52] So full arch implants for a lot of people are not an option because of the expense, because of the time it would take, because in my case, they'd have to drive a ways. It's not convenient, it's not close.

[00:05:04] And honestly, from a dental standpoint, sometimes full arch implants freak me out a little bit because the amount of bone reduction you have to do to make it work. If you're looking on a CT, and the bone reduction guides, you're like, oh my God, you're cutting

[00:05:17] half this person's face off. It's unbelievable. And so I have a suspicion you have solutions for a lot of these problems. Are there other problems that you can think of that you were trying to address outside of the ones that I just gave you?

[00:05:30] Yeah, I've got a truckload more problems. It's the nature of the beast. And full arches are a special case just from the fact that they're becoming much more prevalent, they're becoming much more popular as far as doctors doing them. They're talking patients into it.

[00:05:57] Patients are getting to the point that they say, hey, I want something akin to real teeth again. And it's really kind of amazing just from the fact that in our practice, we do a lot of – we're a general dentistry practice that's focused on implants.

[00:06:17] We kind of have two practices in one. And everything has grown out of our practice. We talked about this before. I practiced with my dad for like 20-something years. Whitefields have been doing dentistry in our part of Nashville for about 60, 65 years now. Okay.

[00:06:40] And it's really kind of interesting because now I am still seeing a ton of patients that had implants done back in the 80s. And those patients are older. And when you talk about them going downhill, patients are really living longer now.

[00:06:59] They are – they're really doing a lot of research online. They're finding out more of the ins and outs about what the realities are about replacing an edentulous arch. And it's super interesting to me, the NIH, we've got studies that the National Institute

[00:07:19] of Health, the CDC, it just shows across the board that if you are edentulous, you're probably going to die five years before everybody else because everyone has – you've got more diabetes, more hypertension, asthma, sclerosis, cancers, these type things. It's just basic malnutrition.

[00:07:34] No, I'm not going to – I'm not going to say that there's correlation and causation there. But yeah, that's not a list you want to be on. Let's just say that. Well, just to go the other way, no, you're exactly right.

[00:07:47] Because people who end up edentulous probably don't take care of themselves in a lot of ways. So my suspicion is that the disease stuff isn't caused by having no teeth, but the disease state is also – people who don't take very good care of themselves are probably

[00:08:00] the people who have these same lifestyle diseases. I think, yeah, there's a real correlation there. You're right. There's another one – But you can't eat as well. You can't eat as well. You cannot – You can't chew glass. You cannot ingest food and drink as well. Simple as that.

[00:08:14] Yeah, yeah. I mean, there's – to what degree of correlation is there? I agree with that. There is – I even saw a study that showed some of the founders of Clear Choice. They did a study recently, Don Maloney, and they showed it to me.

[00:08:29] They showed if you're able to give someone teeth again, like the ability to masticate in a fully fixed functional way, they can knock down your A1C by a full point. And I was like, okay, that's – and they've got a study that they're introducing right

[00:08:45] now on that, which is kind of neat to me because we have a ton of diabetes down here in Tennessee. I get it. We've got plenty up here too. Yeah, but it's really interesting because back when we spoke a couple of years ago,

[00:09:00] a lot of what we were talking about is, hey, wouldn't it be nice if or wish we had this or if someone could come up with a system that gives somebody biomimetic function again in an affordable manner. In an affordable manner.

[00:09:16] And to be honest with you, that's what we've got. That's what we've come up with. And the concept – I mean, our trademark name is ZirconX. That's what I call it. It's a full monolithic zirconi bridge. But the –

[00:09:34] Just so people know, the website you can – I'll put it in the show notes too, but it's zirconx.com. ZirconX.com. Yeah, we're redoing the website there to make it a much cleaner flow as far as a doctor going and seeing what the concept is.

[00:09:51] The AAID has asked us to come and lecture on this at the district meeting April 12th and 13th, 14th here in Nashville. And they want us to lecture on specifically – they came up with a name for this concept. Nobody knows how to really describe it.

[00:10:11] And we had trouble describing it, but they hit the nail on the head. It is a fixed removable attachment system. And it's amazing. It really is. It's extremely cost effective for both the doctor and the patient. It functions like fully fixed. I mean, it's in there.

[00:10:31] They're not able to take it out like locators. It is to some degree like locator fixed, which is a phenomenal system. We have fixed several of the problems – I say problems they have. We've got some solutions for issues that you have to work around like angles, retention.

[00:10:53] We're able to couple it with full fixed zirconia so it's able to be clean better. The intaglial surface is a whole lot nicer than – Than the acrylic, sure. But the patient satisfaction is going very, very well for us. It's super easy to take on and off.

[00:11:13] The doctor does that. And super easy to take care of it with water, picks, and electric toothbrushes. Okay. So let's go through a little bit of what the differences are. First off, just so people understand, it is not screw retained.

[00:11:27] So there are no screws from the restoration into the implant abutment. There are no screws anywhere. Dr. Leo Moline, who is kind of my mentor, he and I work very closely together. He's really the one that invented this.

[00:11:44] He has the patent on the attachments and snaps and it's brilliant. It is a brilliant thing. What it does, because he has eliminated the screws, because of that we've eliminated 90% of the problems involved with screw retained.

[00:12:00] We don't have to whack off all that bone for VDO screw channels. We don't have to do that. We keep every micron of bone that we can hold on to. The installation and the removal and long-term maintenance is super easy.

[00:12:19] It's a lot more akin to a denture workflow, to be honest. On top of that, the big thing that really helps me out more than anything is angles don't matter. When I say that with implants, what we do with our system is we place the implants in

[00:12:38] the most ideal positions where we can find good solid bone. We have angulations of, we could be off up to 30 degrees and we can correct it because this system, the angulation discrepancies are corrected with the MUAs. That's the beauty of it. This is an MUA based system.

[00:13:00] It's the first- For a beginner who doesn't know anything about it, what does an MUA stand for? MUA stands for multi-unit abutment. They're the little cone abutments that everybody uses. They're like the CONUS or the ... There's a lot of systems that use these things now,

[00:13:16] but you have a specialized MUA. Is that right? It is. They call it the MUA plus. What it is, is every MUA out there, there's only one way to use it. You screw the prosthesis on top of it. It was created for screw-retained prosthetic.

[00:13:34] We use the same abutment, but instead of having screws, we attach it with peak snaps, which peak polyethylethyl ketone- It's a very sturdy plastic is what it comes down to. It's a real ... They literally are milling restorations out of this stuff. It's very sturdy stuff. It really is.

[00:13:56] Well, what they were able to do is we were able to put it together so it can snap on and be as retainive. It functions like regular crown and bridge on natural teeth. Removal is with ... We use the bridge removers.

[00:14:15] Well, we use bridge removers is what we use. It doesn't ... The patient isn't even going to get this thing off accidentally. It's just not going to happen. As a general rule, no. They can come loose.

[00:14:28] I mean, they can knock them loose every once in a while, but in reality, we've had up to 25 in function for about a year and they're really performing very well. They're meant to be taken out at the recall visit, not- Yes. Yeah, okay. Okay. Yeah.

[00:14:44] We just schedule a regular recall visit. We schedule a little bit more time. It's not like you have to block off an hour and a half to- Sure, sure, sure. ... unscrew something and try to get it back. Oh my God, yeah.

[00:14:53] Well, that's in ... Well, anyone who's done any recalls on full arch screw- Oh, yeah. ... screw-jaded implants, first off, getting to the screws is not always the easiest thing and getting them to loosen up is not always the easiest thing.

[00:15:05] Sometimes the fear of having to replace a screw and if you might not have the screw, it's like some of these headaches are very real. That's kind of a ... What you're saying is that that's just not ... It's not a concern with this system.

[00:15:18] No, whether or not it's screws, it's funny. I was meeting with Danny Domain down in Lafayette about three or four weeks ago and we were discussing that and he, to combat this problem, even he developed a custom screw. I think it's called the Vortex.

[00:15:34] Yeah, the Vortex, yep, yep. Yeah, and he did it specifically so these things would not come and lose. Well, what we've done is we feel that we've eliminated the weak point in the whole system.

[00:15:48] It's interesting too because like, okay, if you go on your website and someone is going to say, well, it looks like a locator. I mean, conceptually, it's somewhat like a locator, just snap. How do you get the snap into ... There's so many questions.

[00:16:08] Okay, so you're going, is this a same day, teeth in a day thing typically or not necessarily? It can be. It can be, okay. It actually simplifies that process dramatically compared to other systems.

[00:16:24] You got a lot ... The key is we have a lot more wiggle room in the installation. Yeah, yeah, yeah. That's for sure. That's for sure. That makes a lot of sense actually, yes. Yeah, and so whatever protocol the doctor wants to use, we typically ... I mean, we typically,

[00:16:40] the patient- And by protocol, let me interrupt you. By protocol, you actually mean digital or analog? Yes. That's the other thing. A lot of these teeth in a day things require really precise digital everything, which is cool. Don't get me wrong. It's awesome.

[00:16:56] We love that and I think that's interesting, but on some level, there is a lot ... There's a lot of technology required to be able to deliver that necessarily and this doesn't require ... It can.

[00:17:10] It works great with the digital system from what I can tell, but it also doesn't require a digital system. Is that right? Yeah. We've done it both ways and we've got workflows for both and they both work like a charm.

[00:17:27] When I was constructing our curriculum about learning, I was thinking, okay, I'm going to have to teach a lot of doctors about this and doctors are all over the board. I mean, in our office, we've got all the technology in the world.

[00:17:40] I mean, we've got ... And we use it. We use AI in a lot of different ways and that's not to get off on this. There's a lot of AI involved with this, a lot of different levels that people don't

[00:17:52] really even realize, but you don't have to have any digital technology in your office to perform this for a patient. Like I said, the analog way is super straightforward. It's like making a denture.

[00:18:06] It's not just like a D1 can do this, but when it really boils down to it, we've eliminated the vast majority of the complexities. In all honesty, I do it analog probably more than I do it digital.

[00:18:23] We have the ability to take it all the way through digital, pretty straightforward. We're even working with XNav Technologies. We're about to introduce some photogrammetry in with that and we've already performed from start to finish a couple of full arches from the initial planning all the way through

[00:18:47] to the final prosthesis and we did it completely digitally. We did no impressions, no bites or anything. The only time we touched the patient was to screw the implants in and put the prosthetic on.

[00:18:58] It can be done and it can be done very well, but this democratizes full arches for any doctor, no matter what level of expertise. There was a lot of this, especially the zirconia stuff, they really pushed a digital, which is great.

[00:19:16] Like I said, which is great, but not everyone's into digital yet. This allows for a lot of different things. Walk me through the workflow. Like a patient walks in the door, you and the patient decide that a full arch prosthetic is a good option for them.

[00:19:36] They're dentate, at least partially dentate to start with. What's the first appointment look like and take me all the way until they've got teeth? Well, I'll run through the digital workflow real quick here. We'll continue about that case we just spoke about.

[00:19:55] That patient came in, we took a CT. We planned it a little bit ahead of time, but you can do this all in one day. Take the CT, upload it to XNAV, we plan the case surgically, remove the teeth, went straight

[00:20:09] into our guided dynamic surgery, placed the implants exactly like we wanted them. Same day as teeth out? Yes. That protocol is up to the doctor. People do it all kinds of ways. We placed our implants, then we immediately went to scanning and we used photogrammetry

[00:20:33] and we exported it into ExoCAD where we were able to 3D print a provisional, which is the same design that we would use, same STL file. We 3D printed it and doctored up real nice with some pink gum tissue and installed it that same day.

[00:20:53] That was the basic workflow for digital. For an old school analog, which is what I do a lot, we bring the patient in. Say we're not going to load. Say the patient already has dentures. We keep that vertical as long as we're happy with it and everything.

[00:21:13] We can use the dentures and retrofit and attach them if they're existing or we can have them some dentures made and ready. We place the implants. Again, when I go back to angles, a lot of times angles, we use this with implants that

[00:21:32] are angled around the middle foramen, angled around the sinus, but we also do it quite well with pterygoids because you've got some bone back in there that you think, oh, that's an angle that would be really difficult and it's impossible with other systems.

[00:21:47] For example, locator, excellent system, but if you're off on more than 10 degrees- Yeah, there's not a lot of play there. That's right. I can say that with some experience. Yeah, we have 17 and 30 degree MUA abutments that immediately correct it. We place our abutments.

[00:22:07] You could potentially place your MUAs on immediately loading the implants that you just placed. Is that right? Yeah, you can place them and then if you've got a pre-made prosthetic, you can attach at that exact moment.

[00:22:27] We also, with our impression system, we've got a special impression coping that allows us to construct on the intaglio surface of the final restoration, our divot or our hole. We don't have a screw channel. Again, it's monolithic so our bridges are stronger. They don't have holes through them.

[00:22:47] That's a huge deal by the way, yeah. We rarely have, we haven't had any fractures. The only fracture I've ever had is one that I ground all over and I shouldn't have been doing it. Sure, sure, sure. It's amazing the durability.

[00:22:59] But with our analog workflow, we've got a special super simple impression coping that we snap onto the MUAs. MUA, sure. And it allows, it helps out on the lab in the things as far as constructing the underside of the intaglio and makes installation a lot easier.

[00:23:20] Oh, that sounds great. So, okay. So you've got, let's just say either you've got MUAs, you've placed them, maybe you're not placing, you're maybe not loading the same day you're coming back, you have a prosthetic. And how do you get the peak attachments?

[00:23:38] How do you stick that into a zirconia, a full, you know, like a monolithic zirconia restoration? The underside, the negative, the hole or divot, whatever you want to call it, it's a passive fit. And that's back to our special impression copings.

[00:23:58] They're this larger, there's a perfect little size. We use chair side or some other type of acrylic to pick them up. I'll take a donut and I just kind of score a little bit of a- An undercut of some sort. Yeah.

[00:24:14] An undercut and they lock in and they stay. It's really kind of amazing. Yeah. With the pass... It's so funny because so many denture pickups I've done with locators in the past, like I think I have a passive fit and then I don't actually have a passive fit.

[00:24:28] We're big on that. Let the lab figure that stuff out. Oh, and by the way, these things are impossible to lock on. We don't even... Is that right? Yeah. And believe me, I've locked on all kinds of locators.

[00:24:42] If you've done implants as much as you have, you've locked some stuff on. That's horrifying. Exactly. Yeah. But that's a big thing because the removal and then the replacement, putting it back in is pretty darn simple.

[00:24:57] And then the patients, again, they can't get it out, which to me is a benefit because I have a lot of other patients that have locators and they're supposed to take them in and out and then their older people don't have dexterity. It's a weird little system.

[00:25:12] They get frustrated. They build the nylon snaps. It eliminates all that stuff. Yeah. No, that sounds really good. I mean, and the fact that you're using for the final restoration, you're using a zirconia, the strength of it is really...

[00:25:27] And that you're not putting a hole through the zirconia, which is kind of cool. Like you said, you actually have the passive fit milled into that bugger so the pickup is already going to be easier because the lab did that passive fit into the zirconia.

[00:25:39] I mean, it makes a lot of sense to me. Yeah. The zirconia, the final restoration is really the magic. We're getting kind of dialed in with our designs. It's a special design even though it's a simple design, but it's kind of special.

[00:25:55] But we're having a ton of good success with this compared to acrylic or whatever. I'm curious about bone reduction because you mentioned back that like you don't have to reduce as much bone.

[00:26:09] To someone who's still kind of new to this procedure and this concept, why is this less... Why do you need to remove less bone? Well, again, the whole... For years, I'm an AAID guy. For years everybody's been talking about, we all talk about bone conservation, but every

[00:26:30] doctor I know goes in there and just absolutely whacks the heck out of it because they have... It's mortifying. It's mortifying how much bone... It is. In some cases, how much bone you take away to make it work. We were...

[00:26:43] Well, I went and helped a buddy of mine and they were running a course a while back, a full arch course. And I took a bunch of pictures of how much bone they removed. And now because this is such a common thing, there's even a common...

[00:27:01] They've developed a really common procedure for removing a large amount of bone very quickly. And that... Well, unless you... Until you've seen that in working, ooh, you don't really realize it. And the question I've got is how many of these patients on down the road are really running

[00:27:20] into problems? And I've got patients that have already gone for... I got one, a girl that I grew up with, she had to go to Vanderbilt and get it done for zygomatics. That's big and she barely got one. Yeah, that's a huge... Yeah.

[00:27:36] I have an oral surgeon buddy who's super worried about this procedure in general because of that, especially... It's one thing if it's a healthy 70-year-old, it's another thing if it's a 30-year-old who's

[00:27:50] doing this, because they got to go a long time on these implants to make them work. And so it's... Well, look. I mean... Yeah, the whole basis of our philosophy is bone conservation across the entire landscape. I taught this concept at Bernie Dunson's Maxi course several weeks ago.

[00:28:11] That was one thing that Bernie really liked. He was like, okay, we get to keep all the bone because that's a problem that everybody deals with, everybody does it, but nobody's got a real good solution.

[00:28:23] And I got to tell you, if you're listening to this and you're like, okay, I can't picture this, the website, even if you're doing something to improve the website, the website is pretty good.

[00:28:32] But the first image is like literally the first image you see probably tells you more than you need to know. And then there's just like, you can kind of see that this isn't necessarily a procedure

[00:28:42] where you have to whack off a bunch of the alveolar bone to make this work. You're sort of working around the existing bone on some level. Would that be accurate? No, that's exactly what it is. We find good bony sites. And again, angles don't matter.

[00:28:58] I'm not saying you go in all willy nilly, but if you've got a good area bone and it's say it's in the pterygoid area, that's where we're going to put an implant. And we're able to- You're figuring out the angles beforehand because you're planning this digitally anyhow

[00:29:14] off of a CT. You just know that you've got a lot of different options angle wise. Is that what you're saying? Well, yeah, it opens up a whole other world. It's all about the bone. We say it all day. It's all about the bone.

[00:29:25] If we've got bone, we're running and gunning. But it really opens up a world of full arch fixed implants for folks that otherwise would not be able to have real teeth again. So you're looking at this and you've done a bunch of full arch.

[00:29:43] You know full arch stuff, the screw-retained stuff. Are there any situations where you would prefer screw-retained over this at this point? No. I'll never do a screw-retained again. Just because of the problems you've run into, you'd prefer to just avoid those problems.

[00:29:58] Well, I believe that this concept is a much, much better mousetrap for both the doctor and the patient. But just from a procedural standpoint in conservation and long-term success, that's another thing that we're really illustrating a lot.

[00:30:18] We feel that this is going to have a lot better chance at having some real long-term success. And on top of that, this is kind of, to a large extent, it's repairable. We've got B plans here.

[00:30:32] A lot of times when you go to all on four screw-retained, you whacked off bone. If it falls apart, there's no beef. We over-engineer these things to the best of our ability. We put in minimum, we include six implants and components with our system.

[00:30:51] We tell our doctors, put in every single implant, even if you bury one or whatever, have it for an inch. Over-engineer this thing. And that's what we teach and that's what we believe in. It's interesting. The concept is very interesting.

[00:31:07] And I suspect there's people, there's appeal for people, it's funny, there's appeal for people who have done a lot of all on fours and are nodding their heads at the complications that they have with screw retention.

[00:31:22] And then there's people who've not done full arch who are hearing, okay, this simplifies it and this makes it so it's maybe less bone removed. And frankly, you don't have to do it digitally. You don't have to.

[00:31:35] There's appeal on kind of both ends of the spectrum of potential clinicians who are interested in this. Are there any patient considerations that are different compared to this procedure over other procedures you've done in the past?

[00:31:50] Are there more patients that could do this than maybe couldn't do other stuff? Well, the short answer is absolutely yes. And the big reason is cost savings. I don't know if you remember, when we were talking back a couple of years ago, we were

[00:32:05] kind of talking about some costs and how the cost is kind of going out the roof. Yeah, that's one of the holdups. We're used to patients spending $25,000, $30,000 on an arch and everybody is praying that it stays together for the long term.

[00:32:24] But what we're able to do because we've been able to condense the workflow and we've cut the overhead in half for the entire system. And so our system, all the components and parts, the whole shoot and match, including the final prosthetic and temporaries is somewhere around $5,000. That's everything.

[00:32:47] Okay. That's labs. That's lab and everything. Okay. Yeah, with the screw retain and it's all in one package. It's one box. Okay. So, and this is also something I didn't mention before. This is a proprietary implant.

[00:33:01] The implants that you use with it are a very specific implant for the system. Is that correct? It is. It is Dr. Leo Moline's implant. It's Implant 1. His company is Implant Logistics and I've used every implant out there. It's a phenomenal implant. It's got a phenomenal thread pattern.

[00:33:21] Leo is the Steve Jobs of implant dentistry. He really is. He is the best surgeon I've ever seen. He's amazing with technology. He's designed an incredibly excellent system and he just kind of dreams stuff up, writes on a cocktail napkin, goes to his factory and makes it.

[00:33:38] And the implant itself, personally I think it's the best implant I've ever worked with. It's got a nominal connection, a deep Morse taper connection that is beautiful. We place them about 1.5 millimeter sub-crestal. We get phenomenal platform switch bone growing over the top.

[00:33:57] We really concentrate on getting good solid osseointegration across the entire board. Then at that point, from that point on, we feel like we're cruising. But when it really boils down to it, the implants itself, yeah, it is proprietary to his system but it's worth it for full arches.

[00:34:15] That's cool. I mean, it's cool to know that. So what does a kit look like? Like how do you, when you, let's say, okay, I'm dropping five grand for this whole kit. What am I going to get in that and how does that work?

[00:34:30] We're putting this all together right now. We're going to be releasing in the next two or three months a retailer commercial kit. It's a case by case basis. Our surgical system and our drill kits are very small, very compact, very efficient and cost effective.

[00:34:53] The doctor has to buy that on the front end but for every case, the doctor fills out one of our implant assessments. It's like, hey, tell us what you're doing here. I'm trying to make our doctors think about their game plan and we help them game plan

[00:35:11] surgically and digitally for every case. So it's kind of like an order form. Hey, what are you doing here? Where do you think you're going to put your implants? Let's talk about an A plan, a B plan for this. And so we help the doctor plan the case.

[00:35:27] Then the kit comes with six implants. It comes with all the components that we need which include transfer copings, the final snaps and all the abutments including the angled abutments that we need. Then it also comes with a voucher.

[00:35:47] You figure the angles from the CT that you're planning from, correct? Yeah. A lot of this, believe it or not, does turn into kind of freehand stuff. Because when you're locked into a digital pre-plan, you got to put them there. You can't move it around.

[00:36:03] If the bone's not good, you still got to stay there. We have the ability to kind of do whatever we want. And then also in the kit is included a voucher for a 3D printed, we call it Flex on X prototype and the final prosthesis also.

[00:36:23] That's really okay. So that's really cool. So you have a provisional slash prototype for the patient to basically check off the box that this is what you want, this is what you like prior to going to the zirconia. That's really cool. Yeah.

[00:36:38] We've learned that that is a crucial step. Yeah. Because otherwise it's easy to get off midlines, cans, whatever. That's very cool. That's very cool. And I mean, for a full arch zirconia, God, with a provisional, that's a pretty good deal. You've taken the cost down significantly.

[00:36:58] We feel that, I mean, we've kind of done the math. If you use any other, I mean everything else for screw retain, you're going to be closer to like nine, $10,000 for it. And then you have to do different companies and put it together.

[00:37:10] You might have to go to four different companies to get your parts, components, labs, and all that stuff. So what is someone who can do this well with some reps and who knows what they're doing with this? What are they going to be charging the patient for this?

[00:37:27] So when rubber hits the road, you're saying, okay, more patients are going to be able to do this because it's less expensive. What's the patient expense going to look like? We are doing something in the 15,000 to 17,000 range per arch. Per arch.

[00:37:44] All in one package, including any grafting or whatever. We don't nickel and dime. We're like, look, Betty, we're going to get you- We're going to give you teeth. Yeah. Yeah. And that's what they want to know.

[00:37:55] And the funny thing is we figured out that this is far and away the most profitable thing we do in our office because it takes, I mean an experienced clinician like me, we can do this including the surgery in four to five hours total. Let's say five hours.

[00:38:16] And at five hours, if we charge, say, the Murray's Round number is 15,000, that's $10,000 profit on the case. You know your hard cost start to finish is 5,000. So that's $2,000 an hour of profitability. It's a win-win for the patient but also the doctor.

[00:38:33] So in all of our research, we've done a ton of analytics and we're looking at all kinds of data and everything. And far and away, the biggest query online or all the questions are how much does it cost? The patient's desperate to find out.

[00:38:49] They're desperate for teeth but they really just don't have an idea about cost or anything. No, why would they though? Why would they though? Yeah. Like the reality is, I know I totally get that from their standpoint because you could

[00:39:01] tell them it costs $2,000, you could tell them it costs $50,000 and they wouldn't be surprised by either one of them because why would they know that? That's right. We're showing that if we make it a little bit more affordable, we're having a lot more

[00:39:13] patients go, oh, I can do that because even on screw retain on top of that, they go to a surgeon and then go to another doctor. They get super confused and they get sticker shock all over the place. Mm-hmm. So. No, that makes a lot of sense.

[00:39:29] There's a lot here to dig into. There's a lot here to like. So then the next question I have is what does someone, if someone wants to do this, if someone is interested in doing this, learning about this, you have somewhere where they can go learn more.

[00:39:45] Is that right? I mean like you have a place for dentists to come learn this technique. Yeah. We, yeah, I'm based in Nashville. I'm lucky. I am, I mean, I've been here my whole life but Nashville has become the epicenter. Everybody wants to come to Nashville.

[00:40:01] It's kind of funny. And it's really interesting because Nashville, we're now, we're creating a lot more venues, clinical and lecture for CE courses. We teach this. We actually have several different locations in Nashville where we teach depending on the size of the group.

[00:40:25] But we're just in the next while here, we're going to be launching some, you know, focused CE courses specifically designed for Zirconics, hands-on workshops. One thing that's important, you know, that a doctor handles it but once they handle it, they see, oh, this is pretty straightforward.

[00:40:44] I think I could pull this off my office myself. And you have, it looks like you have some kind of an online training. Is that right? Is there a spot that they can, okay, so I'm looking at the website and it looks like there's an online training.

[00:40:57] Yeah, we've got some dates coming after April. The district meeting, we're really helping out with that. The AAID, we're putting on some hands-on workshops there. By the way, that's a great meeting, folks. April 12th, 13th, 14th, the AAID has the Southern District meeting. Lots of great speakers.

[00:41:13] I'm a big AAID advocate. Well, I'll put that link in the show notes because people will then, knowing that you're going to be there too and there'll be some stuff going on there. There's the online where they can do it here and then we'll keep posted because obviously

[00:41:26] you're going to be opening up with some. This is going to catch fire, I think. There's a lot to like here and so there's going to be a need. And honestly, people are going to want to be able to do as much hands-on with this as

[00:41:36] they can, especially if they're newer at implant restoration. And to be honest, honestly, Mark, I feel like this has potential to bring more people into implant placement for a lot of reasons.

[00:41:49] But some of the reasons are what you were saying is the, I hate to say it, but I mean partly because you don't have to have everything so tightly digital. And like you said, with digital, everything has to be placed exactly.

[00:42:02] Like there's a little bit more room, a little bit. It's not slop room. It's just a little bit more wiggle room to make this thing work. And I feel like there's maybe more potential for newer clinicians to give this thing a try. Oh, absolutely.

[00:42:15] I've said it over and over again. We feel like we're democratizing implants for both patients. And it's really true. We've got tons of millennials that have worked with us that have performed case. I say tons, several. They perform very well.

[00:42:35] One of my partners, Joe Rogers, he picks this up and boy, he goes like gangbusters. And it's really kind of neat to see somebody who's somewhat of a neophyte pick it up and do it and actually give somebody real teeth again. That's it.

[00:42:51] It has a lot of appeal. And frankly, it's the complexity on some of this stuff has kept a lot of people from even bothering to look into it any further. So I kind of like this. So again, the product is called Zircon X.

[00:43:06] We'll get you all the links will be in the show notes. Mark is wildly available to talk about it. So I'll make sure you guys can get in touch with Mark real easily. And I guess this is interesting, Mark. I'm excited.

[00:43:17] I know it's still kind of early on in the process, but I feel like this is going to take off like crazy. So if you really want to see what's going to happen, that AAID meeting sounds like the place to be. That's a couple months down the road.

[00:43:29] Yeah, that's great. And I appreciate you talking with us tonight just from the fact that, you know, it's dentists like you. It's dentists like me who are just out there searching for a better solution, something better for their patients, something that's actually affordable and practical.

[00:43:46] That's why I'm all just so amped up about it, because in all honesty, it has solved a world of problems in my own practice. And that probably extended my career a few years, if you really want to know. Sure, sure. I get it. I get it.

[00:44:00] Well, that's awesome. Mark, thank you a ton for being on. And like I said, we'll make sure if you have questions that Mark gets them. And we'll talk to you again real soon. All right. Sounds good. Hey, thanks for having us. You bet.