Very Dental: How to Talk to Your Lab with Dr. David Hornbrook

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

[00:00:17] 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 and benevolent leader, Dr. Alan Mead.

[00:00:31] Very Dental people, welcome back to another episode of the Very Dental Podcast. I'm your host, Alan Mead. I have a very special guest with me. I'm sitting here in the lecture hall.

[00:00:41] of my study club that I've talked about incessantly for the past several months, The Vetter Society, here at the Shanty Creek Resort in Northern Michigan. Joining me is Dr. David Hornbrook. David, how you doing?

[00:00:51] I'm doing great. Really good. It's been a good weekend.

[00:00:53] Yeah. So, David started yesterday, early in the morning, and lectured all day yesterday, half day today. It's Saturday afternoon. He's got another half day tomorrow. And this, like I've said before, my study club's the best value in all of dentistry, dental CE.

[00:01:10] And it's, there's a lot of good camaraderie. And to be perfectly honest, as we were saying, we have a catalog of speakers that have been here over the past and it's a literal who's who of, of dental CE. So it's a, David was joking. He said, either I'm insulted or really glad to be here because, because I'm really glad you invited me. But you know, where you been?

[00:01:29] That's why I said, they said they've been doing it for 65 years. That's what I said. I'm, I'm honored that I was included with all these people, but a little insulted that it took you 65 years to invite me.

[00:01:38] I'll say this. David is a really good fit for this group. I think, I think the better folks, a lot of them, a lot of them are, um, how do I say this? How do I say this? A lot of them are, um, grizzled veterans of, of restorative dentistry. So they've seen a lot of, they've seen a lot of CE, they've done a lot of dentistry and they're really appreciating what you've got. I mean, they really are.

[00:01:56] They're very highly educated. You know, I was, I was mentioning that at the lecture yesterday was it, it really motivates me as an educator when I get great questions. And when I sit there and everyone looks like deer in headlights, you know, it doesn't really motivate me to take it to the next level, but you're right. These dentists, there's prosod on us. There's dentists been in practice 50 years. They've been educated, you know, with the people that you talked about and the questions are great. Keeps me on my toes. And it's like I said yesterday, if I don't know the answer, I'll make something up. Sounds intelligent.

[00:02:28] It's been really, really fun.

[00:02:30] It's what's cool too, is that the vetter literally it's 13 hours of CE. So you don't get 13. It's there's that, you know, getting a day at a state dental meeting is one thing. And then doing like a Koi's continuum class. It's like just ridiculous. We're sort of in the middle of that. And so it gives you a little bit of more latitude to cover material. You don't always get to cover, but it's not like a full symposium. It's not, you know, it's not like a full, uh, you know, class one of a

[00:02:56] bunch of things. It's a good amount of time for some, I will say for some speakers, it may be too much. It may be too much. Like they have to spread their stuff. You definitely don't, but there's some that have in the past.

[00:03:07] You know, it's, it's a good, I'll tell you, it's a good mix. And again, I mentioned this yesterday that most of the time I come in and you know, your listeners, many have heard me speak. You know, I come in in the morning and I've got to catch a plane that night. It's like 430. It's like, sorry guys. But you know, the sign says we end at 430 and I got to catch a plane. And I feel bad. But at the same time, my relationship with the audience kind of ends there until I see him again. Right. And many of them I may never see again. And the cool thing about this is, you know, we ended yesterday at 430 after a full day. And it was like, you know what? Yes, I get to see these people in the morning.

[00:03:37] Cause a lot of them have questions. Yeah. And a lot of them went to dinner last night talking about the stuff you were talking about. So, Oh, I guarantee it. Cause that's how, that's how it is. This is, you know, the better is you get a bunch of CE, but you also get a bunch of, of the, you know, the, the gabbing with your, your colleagues and friends at dinner or whatever. And literally that's one of the reasons we started the podcast. Cause like, this is, this was always supposed to be kind of like amongst colleagues at a CE event or, you know, going out for dinner. And it's definitely, so you get two nights where you get to go.

[00:04:07] And like right tonight, people will be having a dinner, wondering what you're thinking, what to ask you tomorrow.

[00:04:12] Yeah. And that's, that's a huge benefit I think for the audience as well, because they can rehash some things and there'll be some confusion. You know, I could say one thing and two different people hear, you know, two different things.

[00:04:22] Exactly. And they can talk about that tonight and they can ask me tomorrow. And so, you know, the nice thing about this guy, I'm a relationship guy. I mean, you know me reasonably well. Um, and this is a, this, this program is a relationship deal, which is cool. Cause I get to see these people, right? I get to know their names. Most of them. Yeah. As long as they keep the name tags.

[00:04:40] What's really funny. It's like, like I sat up front, uh, both days actually. And, and, uh, my dad was sitting in the back cause you know, my dad is the one who got me here and he's teasing me. He's like, Oh, he found you again this morning, you know? Cause it was a, so if you're sitting in the front row at one of David's it's, it's like, uh, it's like Gallagher, you know, he like, he smashes the watermelons.

[00:04:59] If you're in the front couple of rows, you're going to get wet. That's right. You're going to get some on you. So.

[00:05:04] And that's again, another great thing. We talked about this. I talked about it yesterday was, you know, for the last 15 months, it's been a bunch of zoom. Oh my God. Yeah. Totally. I did 37 zoom meetings. Yeah. And I'm a really, I want to see your response. I don't want to call you. I want to look in the eye. If you have a question, I want to hear it. I want to see who's asking the question. David is an eye contact guy to the, to the almost uncomfortable. A lot of eye contact up there, a little, a little uncomfortable, but yeah, you're going to sit in the back tomorrow.

[00:05:29] Yeah. Great. So, okay. One of the things I have a list of questions that I wrote down, I, I, but I know the one that the one that is probably going to be the title of this thing is, um, go visit your lab, have a relationship with your lab. So, and you were saying you are, you come at dentistry. Clearly you've, you've got a ton of restorative chops and everything, but you are, you are a materials and a lab guy in a big way.

[00:05:54] Big time. And I think that anyone who's probably seen you lecture realizes that you, you, you see it from both sides. How did that start? In other words, how did you get to realize that, you know, the lab, how did you become sort of a lab liaison guy? Honestly, I think probably when you lecture, people are expecting you to talk about a lab aspect on some level.

[00:06:13] Yeah. I mean, I've been accused of thinking like a ceramist, you know, and I think that's made me a better dentist. And I use the analogy is quite frankly, I think an architect should spend some time with a builder.

[00:06:24] Right. Yeah. That if they're going to design something, there's things that they could do to make it easier for the builder. And there's things that they shouldn't be doing because it complicates the whole building process.

[00:06:33] And I think too oftentimes and not, Dennis has no idea what happens once that impression goes to the lab or what they could or could have not done or done differently to make that case a better case or easier for their lab technician, whether it be a ceramist or whether it be a removable lab.

[00:06:50] So it started out, I mentioned this this morning in 1986, when I graduated from dental school at UCLA, I saw a lecture on a material called concept, right?

[00:07:00] Which was a resin based lab process, resin based, restored material. And it just intrigued me because all of a sudden people are bonding to teeth.

[00:07:08] Not very good because we couldn't really bond to Denton, but they're doing intracronal restoration instead of big, ugly PFMs.

[00:07:13] Right. And so I saw this lecture and, and I forget his last name. His first name was David. And he kept showing this, these cases by Yuri Yerevesky. He was a master ceramist out of LA.

[00:07:22] And I thought, holy cow, man, he's talking about stuff. I had no idea what it was. I've never heard of this material except for this two hour presentation.

[00:07:29] So I called him up and I said, Yuri, this is David Hornberg. You don't know me, but I'm in San Diego. He was about two hours north of me. And I said, is there any way I could come spend like an hour?

[00:07:37] I just want to see a lab. I've never seen a lab, right? I was out at dental school and the lab for us was mixing stone, right?

[00:07:43] Yep. Yep.

[00:07:43] And so he goes, yeah, come on up anytime. So I came up and I spent a Saturday with him and I thought it was going to be a quick hour tour all day.

[00:07:50] Yeah.

[00:07:51] And he went over color mapping and he showed me how he makes stuff and what they do. And, and the ceramics intrigued me because he was a master. He's a, from Israel, master European ceramics. And it was just like, holy cow, this is so cool. I don't do it, but it is cool.

[00:08:06] And so from day one, it gave me an opportunity to say, you know what? I want to know exactly what's going on in the lab so I can become a better dentist and make better decisions. And so now I try to spend, I've been really involved in multiple laboratories throughout my career. Now I'm the clinical director of education and technology at Utah Valley, very digital heavy. And so, you know, every time I go, there's something new, you know, just to see the processing and the thought process of the ceramics and the whole laboratory.

[00:08:35] About how they make stuff, the complications, they interact with dentists. You know, half the time the ceramics is waiting around for information from a clinician.

[00:08:44] Oh my God, I'm guilty as charged.

[00:08:46] And it's a bad deal.

[00:08:47] Yeah.

[00:08:48] And they're trying to wing it because the dentist doesn't give the information they need.

[00:08:52] But they'll get blamed if it doesn't work. And I mean, every dentist, I know amongst their friends, every dentist claims that they give the best information.

[00:09:01] But the reality is, you know, working in a busy practice, man, sometimes you're lucky to get anything filled out on that stuff at all.

[00:09:08] And if you haven't invited your lab to contact you to get more information, you know, it sometimes doesn't happen.

[00:09:16] Yeah.

[00:09:16] It sometimes doesn't happen. It sounds like, I mean, you're probably saying, you showed a lab slip that you fill out for an anterior case.

[00:09:25] And it was, it was, it was a lot of information in a good way. It was a lot of information. And you laughed because you said, as soon as the lab, you know, if it's a bigger production lab, they see this letter, you're getting pulled off the line because you're the pain in the ass.

[00:09:36] You're the one that's going to give them problems.

[00:09:38] And it's the one they got to give to someone that's got the time to really review.

[00:09:43] Yeah. Yeah.

[00:09:44] And even today, some of my weird implant cases on the top of my lab slip, it says in big letters, please read carefully, which means that, you know, they're spending that little extra moment.

[00:09:53] Yeah.

[00:09:53] And it lessens a chance when you get something that's not exactly right.

[00:09:57] Yeah.

[00:09:57] You know, close is not good enough in a lot of our dentistry.

[00:10:00] And, you know, I can say it as a clinician, I hate to say this, but most of the problems we have with our laboratory are dentistry.

[00:10:07] They're us.

[00:10:07] Oh, for sure it is.

[00:10:08] Yeah.

[00:10:08] Yeah.

[00:10:08] And people, and I mentioned this yesterday, it was, you know, your crown, your crown is high in the mouth and you think, oh, you know, that gosh darn ceramics or laboratory is not doing things right.

[00:10:18] First question I say is, is it high on the model?

[00:10:20] No, it's perfect on the model.

[00:10:22] Contacts are perfect, interproximal, but I take it and I had to adjust a bunch of the contacts.

[00:10:25] It's like, dude, that, that model work, whatever you gave the lab, that has not changed.

[00:10:30] The only thing that's changed is the mouth.

[00:10:32] You know, so don't blame the lab.

[00:10:34] Yeah.

[00:10:34] Yeah.

[00:10:35] They, they worked with what you gave them.

[00:10:36] And that's, I mean, that is sort of the thing.

[00:10:38] I'm, I'm curious because you, okay.

[00:10:40] So you talked a lot about digital, but you, but you also had plenty of cases where you're taking, you're taking conventional impressions.

[00:10:46] And I'm curious what you think about, I think sometimes digital is sold as a, as a, how can I say this?

[00:10:55] Uh, diplomatically it's sold as a, as a, as a cure all for a lot of the problems.

[00:10:59] And in the stories, I feel like even with digital, you have to, the details are still important.

[00:11:03] Oh, I think so.

[00:11:04] Okay.

[00:11:04] So you don't have your impression material isn't going to, isn't going to distort because it's electrons.

[00:11:10] Right.

[00:11:10] But the story is, is like, you can still send a really terrible scan.

[00:11:15] I mean, there's a, there's a lot, would you, would you say that, would you say that, uh, if someone who doesn't pay attention, would you rather have them using an impression material or, or digital?

[00:11:24] Which, which can you get in worse, in tougher shape for you think for someone who's not really with attention to detail?

[00:11:29] I think they should use traditional poly.

[00:11:31] Yeah.

[00:11:31] Poly either.

[00:11:32] Yeah.

[00:11:33] It'll sneak.

[00:11:34] The thing about digital and people do, you know, think, oh, as soon as I get an intro camera, you know, I'm going to have this amazing dentistry.

[00:11:39] And it's like, well, one thing, the digital camera will only capture what you can see.

[00:11:43] And we've all had situations.

[00:11:45] We got subgingival margins.

[00:11:46] We don't see it, but our impression material finds it.

[00:11:48] Yeah.

[00:11:49] You know, it finds that.

[00:11:49] Well, you can cheat a ton with it.

[00:11:50] Like as, as I've gone digital, I'm like, oh man, this is an easier impression.

[00:11:54] If I, if I don't use digital, because I can, I can fake it with, I can pick that margin up easily with impression material.

[00:12:00] Yeah.

[00:12:00] And so, you know, it's, it's, you know, it's a little bit of, you know, double-edged sword that you can get more accuracy.

[00:12:07] I absolutely believe that with digital.

[00:12:09] Right.

[00:12:10] And I love the whole concept of a digital file, but you've got to be more meticulous in, in isolating your margins than you do with polyvinyl.

[00:12:20] And a lot of the cases I showed this weekend, you know, I've only been using the scanner for two years now.

[00:12:25] Almost three.

[00:12:26] A lot of that stuff was stuff I've been using, but I still use, you know, I look at some cases and like today, when I talked about my implants, all my implant stuff, especially in the anterior is all polyvinyl.

[00:12:36] Mm-hmm.

[00:12:37] Mm-hmm.

[00:12:38] I think that, well, I think there's, honestly, the funny thing is, is that I think people don't realize that when they send someone impressions, a lot of times, depending on what it is they're doing, you know, you can't, you can't do milled zirconia in an analog fashion.

[00:12:52] It's everything's digital.

[00:12:53] I mean, it's like, so yeah, you can take an impression, but they're digitizing that as soon as it hits the lab.

[00:12:58] As soon as it gets it.

[00:12:58] Like, and there's a lot, labs are moving in that direction where, I'm not saying that stone is ever going to be out of fashion per se, but it's, I mean, it's like, would you say, yeah, you're at a lab?

[00:13:09] How much, when do they not keep it in, when do they not go digital with stuff?

[00:13:17] With any of our press ceramic, if it's not a digital press, that's all still not available.

[00:13:21] So the, so the Lisi, the, the, the newer press, that's gotta be.

[00:13:25] Yeah.

[00:13:25] It's well, I'm not gonna say all stone model.

[00:13:27] If the impression was sent as an analog, right.

[00:13:32] It's probably going to stay stone.

[00:13:34] Yeah.

[00:13:35] If you take a polyvinyl impression for a posterior Emax that can be milled or zirconia.

[00:13:41] Yeah.

[00:13:42] They'll, they'll digitize that impression and they may or may not make a model.

[00:13:46] I mean, you know, the whole concept of why do we need models in the first place?

[00:13:49] You know, it's, it's for people that like to look at their dentistry, you know, like, wow, nice prep.

[00:13:54] Yeah.

[00:13:54] Yeah.

[00:13:54] And I mean, I would say a more complex, like I do plenty of model, a single unit, you know, the, the run of the mill, single unit crown.

[00:14:00] I haven't had a model for a long time just cause it's been working out.

[00:14:03] Okay.

[00:14:03] And you can save money.

[00:14:05] Yeah.

[00:14:05] You know, it's, it's depending on the lab and the size of the lab, it's 18 to 28 bucks to make a model.

[00:14:10] So, you know, if you're doing a single unit, I have no problem with telling the dentist, call your lab and say, listen, don't send me a model, but I want a $20 discount or $15 discount.

[00:14:19] Yeah.

[00:14:19] It's like, okay, that makes sense.

[00:14:21] Well, so, so I'm going to go back to, you said like, what is someone, if someone literally has just been using a lab and they just send stuff to them and maybe talk to the techs every once in a while, that sort of thing.

[00:14:32] What's the benefit they get?

[00:14:33] I literally, I, I'm, I'm going to, I, I go to the lab that I use occasionally, but I haven't gone.

[00:14:39] Okay.

[00:14:40] So one of the guys that you've talked with a lot has a lab just north of, you know, 45 minutes to an hour north of me.

[00:14:45] And I'm going to go, I'm going to go visit his lab.

[00:14:47] I want him to show me everything.

[00:14:48] Cause the reality is, is I kind of understand the fabrication of it, but I kind of like to see it.

[00:14:52] Right.

[00:14:53] Cause I think it's probably different than just understanding it.

[00:14:55] Like to see it happen, to smell the wax burn on all that stuff.

[00:14:58] And so what, what's someone going to get for, you know, what are they going to get out of that?

[00:15:03] Well, I think exactly what you just said.

[00:15:05] I think to be part of the process, you know, let's go back to the architect that's never seen his house being built.

[00:15:10] You know, he draws a plan, you know, sends them off CAD cam plans and never sees it.

[00:15:14] He never really sees the whole process and gets the benefit of that.

[00:15:17] Plus I think by spending some time in the lab, you get a relationship.

[00:15:21] Um, you know, I know the people in the model room of my lab and, you know, I walk in and they say, Hey, Dr. H, you know,

[00:15:28] it's kind of nice to have that relationship because even the woman that unpacks my stuff, you know, she knows who I am, you know,

[00:15:34] and the person that does the model work or the waxing, they know who I am.

[00:15:37] So there's a face with that impression, whether it be digital, traditional.

[00:15:41] And I think that's important, um, as a relationship, but I really think it, it's almost as beneficial to see how they're making your stuff,

[00:15:50] to see what other stuff is being done.

[00:15:53] Sure.

[00:15:53] You know, what kind of impressions, what, what are other cool things that people are doing?

[00:15:57] Whether it's the type of Facebook they're using or the type of articulation system that they're using or the information they're using.

[00:16:04] You know, I like to walk around and I just pull up pans and see what are some of the lab slips?

[00:16:08] Are some people doing things that, that maybe I should be doing?

[00:16:12] Or is it something that a friend of mine that needs to be doing something else?

[00:16:16] I need to send a, you can have a polite little text message.

[00:16:18] Yeah.

[00:16:18] Yeah.

[00:16:18] Hello.

[00:16:19] Hey, it's not your case today.

[00:16:21] Um, but I think it's right.

[00:16:22] I think it's just all about the relationship.

[00:16:24] You know, if you, if you take the time, because traditionally dentists have always put ourselves on a pedestal, we're the doctor, right?

[00:16:30] You're, you're only the lowly ceramist and, you know, don't bug me unless, uh, you know,

[00:16:37] you've got a case that's not going to be on time or whatnot.

[00:16:40] Right.

[00:16:40] And I think it's important for us to say, you know what?

[00:16:43] I want to take the time because I realize you're a, you're as equal part of this relationship and the success of this relationship as I am.

[00:16:52] I want to take the time to come visit you and spend some time with you.

[00:16:57] And, you know, we send pizza, you know, Friday pizza to our lab.

[00:17:00] That's great.

[00:17:00] You know, just so it's like, yeah, you know, this guy's cool and he's a normal guy and he doesn't live on this pedestal.

[00:17:05] Yeah.

[00:17:06] You know, and I, it's funny because first off, if a dentist is not willing to, to take a self-critical look at themselves and like say they've got it all figured out, that sort of thing.

[00:17:16] Not a lot of room for growth there, uh, in a, in a lab.

[00:17:20] I mean, I can only imagine like what lab technicians think about us in reality.

[00:17:24] Cause, cause like a lab technician that's never met their guy, you know, can make a lot of assumptions about someone, you know, like, like, like the, we had people,

[00:17:35] we had three guests that are podcast listeners that came from all over the country to the vetter meeting.

[00:17:39] Cause I've been talking about it for a while.

[00:17:40] I suspect I'm a little bit of a, I'm a little bit of a disappointment, but yet I did get to meet all these people in person.

[00:17:45] It was pretty funny.

[00:17:45] And it's funny when you listen to someone, uh, because we're just audio hearing a voice come out of someone's face is pretty weird.

[00:17:52] Right?

[00:17:52] Like when you're used to listening to it in your head and you're like,

[00:17:54] and you try to visualize that.

[00:17:56] What does this person look like?

[00:17:57] Exactly.

[00:17:57] So I'm thinking to myself, what are those lab technicians thinking about you?

[00:18:00] They probably have a, they probably have a, a picture of you and I'm not sure that that picture all that good on,

[00:18:07] like for me on some of these lab tests, they probably think I'm an idiot sometimes.

[00:18:10] Some of the stuff.

[00:18:11] So I'm like, I almost wonder if just having that relationship means there's a human being on the other end of that,

[00:18:15] that, that you can, you know, you can get to know a little bit and get to know about and know where they're coming from, that sort of thing.

[00:18:20] I think that's important.

[00:18:22] I didn't get, you know, the other way around the ceramics would say the same thing.

[00:18:24] I bet a lot of dentists that are listening, they have no idea what their ceramics looks like.

[00:18:28] I mean, they have no idea.

[00:18:29] And if you're using a big lab, you'll never know who your ceramics is.

[00:18:33] Big giant lab, you know, like I'm not going to name some names, but where you have an account manager,

[00:18:38] but you have no idea who's doing your case and may not be the same person.

[00:18:41] You may not be the same person every time.

[00:18:41] That's right.

[00:18:42] And that's good because, you know, we have preferences, the type of, type of posterior anatomy I like,

[00:18:46] and the stain in the posterior you may not like, but I expect that to be the same.

[00:18:50] Every single time.

[00:18:51] Right.

[00:18:51] And so by having a technician that does my stuff, then I get that consistency, which is really important.

[00:18:59] And I also, you know, also I think it's, it's kind of nice in person to say, Hey, you know,

[00:19:03] if there's anything I could ever do better, just let me know.

[00:19:06] Well, that's the other thing too, you know, cause, cause every dentist listening to this now,

[00:19:10] I don't care what you, you might think that your shit doesn't stink,

[00:19:12] but every dentist here has sent a stinker in there and hoping to get it past them.

[00:19:15] So the, Oh, of course.

[00:19:16] A to make it work.

[00:19:17] You know, if you have a technician that's willing to call you out on that stuff, it's a big difference.

[00:19:22] It's a big deal.

[00:19:22] It's, it's important.

[00:19:23] And, and, and it will probably save you even though it, it stings a bit to know.

[00:19:27] And when you think about it, you've got one or more person evaluating every goddamn thing

[00:19:31] you do that's indirect.

[00:19:33] And I've never really thought about it that way, but you know what?

[00:19:35] Like, I'm wondering if I'm walking around the Chicago midwinter and there's lab technicians

[00:19:38] pointing at me, that's that guy.

[00:19:40] Oh my God.

[00:19:41] Yeah, exactly.

[00:19:42] Well, I think that's how I always tell people if, if you want to know who the best dentist

[00:19:45] in town, like for your family member, the lab technicians, man, call to the local lab.

[00:19:49] They'll say this guy or not that guy or this girl, that guy or that girl.

[00:19:52] But it's, uh, you know, it's sad because lab communication is something they don't,

[00:20:00] they don't talk about in dental school.

[00:20:01] Not at all.

[00:20:02] Right.

[00:20:02] Cause you don't have a relationship with the lab.

[00:20:03] I mean, the lab's usually not on site and they're sending out, you know, it's just not

[00:20:06] the same deal.

[00:20:07] And I think we get out again, we get out and of course there's no lab technician schools

[00:20:12] anymore.

[00:20:12] There's so few programs.

[00:20:13] It's not like you're going to go through and learn with lab technicians right there.

[00:20:16] I was laughing about that.

[00:20:17] I don't even know where lab technicians are coming from, but hopefully they play a lot.

[00:20:21] The problem is there's a huge short every lab is looking for.

[00:20:23] Oh yeah.

[00:20:24] Oh yeah.

[00:20:24] It's a great way to make a living.

[00:20:25] Yeah.

[00:20:25] They're ready to train you too.

[00:20:26] Cause you know, and it's a good way.

[00:20:28] It was just rated as one of the top five careers that didn't require an education.

[00:20:31] You know, I'll give you the idea, you know, the low, the low person on totem pole at like

[00:20:37] Utah Valley is someone in the model room and it's a fun job.

[00:20:40] They're all young.

[00:20:41] Oh yeah.

[00:20:41] Yeah.

[00:20:41] And they're, and that's where all these masters ramers started.

[00:20:44] But now these young kids are going, they started 18 bucks an hour.

[00:20:47] That's pretty good.

[00:20:47] They're listening to their headphones all day.

[00:20:49] They're having a good time.

[00:20:50] Then they move up to digital and then they get to trip.

[00:20:53] I do have to say at a lab too, they can't afford to do it wrong.

[00:20:56] So it's likely that you're learning, you're learning how to do stuff.

[00:20:58] They, a lab can't afford to do it wrong because the remakes will kill you.

[00:21:02] You know, it's like a, so it is interesting.

[00:21:04] You think that probably the guy who started in the stone room is by the time they're up

[00:21:08] to where they are, they know exactly what's going on every step of the way.

[00:21:11] And then, and they also can relate to if we get a case this matter wrong or there's

[00:21:16] complications, they say, you know what?

[00:21:17] I know exactly what happened here because I, I used to do that.

[00:21:20] Yeah.

[00:21:20] Right.

[00:21:21] That's really true.

[00:21:22] But I think, you know, a dentist typically, you know, it's, it's, it's always been just

[00:21:27] a directive relationship and I, you, you know, you and your listeners can agree with this.

[00:21:31] You sent a lab prescription in and you tell them what you want and they send it back.

[00:21:36] Right.

[00:21:37] And I mean, that's how it's always got to start directive or prescription of the pharmacist

[00:21:40] directive.

[00:21:41] Right.

[00:21:41] And then after that, it should be consultative.

[00:21:44] Yeah.

[00:21:44] You know, I would like a phone call.

[00:21:45] You know, I want to talk to this.

[00:21:46] Did I prep right?

[00:21:48] Did I choose the right materials?

[00:21:49] Is there something I could have done different, you know, and, and, you know, I work, I have

[00:21:53] an associate now, but for years I worked by myself, which means I worked with one dentist.

[00:21:57] So what I saw was my stuff.

[00:21:59] That's it.

[00:21:59] Better works are different.

[00:22:00] That's what you're seeing.

[00:22:01] And, and the successes and failures that I had based on materials or whatever were my

[00:22:06] failures or successes where a dental lab, depending on the size, they could be working

[00:22:10] for with 10 to a thousand dogs.

[00:22:13] So they're seeing multiple.

[00:22:15] It's a huge data set compared to what you know.

[00:22:17] Yes.

[00:22:17] And so all of a sudden, you know, a new material comes out and it's in, and you call the lab

[00:22:21] and say, what kind of success have you had with this?

[00:22:22] Well, actually, you know, we've done six or seven of them and they haven't worked out

[00:22:26] or we extrapolated and did something different.

[00:22:28] And we're doing some really cool things and we haven't had any failures and this is a cool

[00:22:33] material or whatever.

[00:22:34] It's a huge resource for us as dentists because of the changes are happening so fast,

[00:22:40] really fast.

[00:22:41] Yeah.

[00:22:42] And it's 10 times faster in the lab industry.

[00:22:43] Yeah.

[00:22:44] I mean, when you go and visit the lab, you're going to be blown.

[00:22:48] I don't know how big of a lab they are, but you're going to be blown away of the changes.

[00:22:52] The whole printing.

[00:22:53] Yeah.

[00:22:54] I mean, printing is crazy, the printing side of it.

[00:22:57] Yeah.

[00:22:57] We were teasing the person I was sitting with yesterday.

[00:23:01] We're teasing you, you have kind of an unhealthy obsession with that, that your milling machine

[00:23:05] because you had about 50 pictures of the milling machine.

[00:23:08] It's like milling machine porn.

[00:23:09] It was pretty cool.

[00:23:10] And it's, which is the, yeah, the concept was really cool because you, you, you asked us,

[00:23:14] so how much do you think this machine costs?

[00:23:16] And it turns out it's not that much more than, than, you know, I was sort of surprised.

[00:23:20] So the technology is moving fast and actually a smaller, you know, lab that doesn't have a gigantic

[00:23:26] budget is still going to be able to do a lot of that stuff on, on site.

[00:23:29] That's amazing.

[00:23:30] That's amazing.

[00:23:31] It's a big difference.

[00:23:32] Oh, huge.

[00:23:32] When lava first came out in 2000, the milling machine was almost 500 grand.

[00:23:36] Yeah.

[00:23:36] It was a three axis.

[00:23:37] It was like a CEREC mill.

[00:23:38] Right.

[00:23:38] Right.

[00:23:38] But the average lab, small lab couldn't afford 500 grand.

[00:23:42] No, no.

[00:23:42] Especially with technology was changing.

[00:23:43] So there's these milling centers everywhere.

[00:23:46] There was a big one up by Seattle.

[00:23:47] There was one in Dallas.

[00:23:48] And so if you sent to a smaller lab, they would take the impression.

[00:23:53] They would send it to the milling center.

[00:23:54] You know, the milling center would mill the coping and they would finish it up.

[00:23:57] And now these labs, you know, they can do it all in house.

[00:24:00] I mean, there's some great milling machines that are 25 grand.

[00:24:02] Great.

[00:24:03] It's funny because like, there's all the different sizes of labs from a single guy to, you know,

[00:24:08] a gigantic glide well size lab and anywhere in between.

[00:24:11] But it is interesting that like, I've, I've worked with a guy who's a single guy.

[00:24:15] So clearly he's sending it to a milling center.

[00:24:16] He doesn't have his milling stuff.

[00:24:17] And I always thought that eventually when he got a little bit bigger and had more clientele,

[00:24:21] he'd want to start milling.

[00:24:22] And he's like, it doesn't make any sense for his lab this, this size to do it because

[00:24:26] the maintenance of the machine.

[00:24:27] So like, there's maybe a sweet spot in there for, for lab size where, you know, they're

[00:24:31] going to have the technology on site because maybe they turn it around a little faster.

[00:24:35] But, but you know, it isn't, you're not a nameless faceless thing.

[00:24:38] There's kind of a, maybe a midsize.

[00:24:40] I don't know.

[00:24:40] Cause I think that's another conversation to have with your lab.

[00:24:44] What kind of technology do you have?

[00:24:45] Where are you going with this?

[00:24:46] What are you able to do in house?

[00:24:47] What, you know, and, and if, if they're straight with you, it's good to know wherever that's

[00:24:50] going and I have no problem.

[00:24:52] I used to work with this Korean ceramics in San Diego.

[00:24:54] I mentioned she passed away a few years ago, amazing ceramics, but she couldn't afford

[00:24:58] even a $25,000.

[00:25:00] It didn't make sense to her.

[00:25:01] So she sent this out, but these milling centers are using unbelievable technology because they're

[00:25:05] working with a thousand labs.

[00:25:07] And you know, the problem is just like a dental office, you know, are you going to go buy the

[00:25:11] new CEREC machine when it's like, well, I don't know.

[00:25:14] Cause it costs a lot and it's my change, my change in two years.

[00:25:16] Of course it will.

[00:25:17] Right.

[00:25:17] And so a lot of these labs are saying, you know, this, this industry is changing so fast

[00:25:22] that why would I invest 50 or $80,000 in a milling machine when the next printer or

[00:25:27] Miller milling machine is going to come out next year.

[00:25:29] One thing I would, your listeners that ever go to the Chicago midwinter.

[00:25:35] Yeah.

[00:25:36] I know what you're going to say.

[00:25:38] I would recommend us to go to lab lab day.

[00:25:40] Yeah, exactly.

[00:25:40] We've done that before.

[00:25:41] Amazing.

[00:25:42] Oh my God.

[00:25:43] You think the midwinter has got a big floor exhibit floor.

[00:25:45] You ain't seen nothing yet, man.

[00:25:46] And the milling machines and the stuff they're doing out of Europe.

[00:25:48] I mean, it just blows you away and, and what's available and it's very cool.

[00:25:53] And it's eyeopening.

[00:25:54] And, and I can, seeing all these ceramics running around like little kids.

[00:25:58] Oh, it's a kid and candy store.

[00:26:00] Exactly.

[00:26:00] And you're like, literally there's so much technology there.

[00:26:02] You have to decide what's, what's it is.

[00:26:04] It's nuts.

[00:26:05] And it's, it's going on at the same time as, you know what?

[00:26:08] Very dental listeners.

[00:26:09] I'm obviously going to midwinter this year.

[00:26:11] I missed it.

[00:26:11] So let's come up with a group of people to come over to lab day as a group.

[00:26:15] So we don't get too overwhelmed by it and take a look.

[00:26:17] Cause it's, it's really, it's something else.

[00:26:19] It really is.

[00:26:20] I've got whatever magazine that they have.

[00:26:22] LMT.

[00:26:22] Yeah.

[00:26:22] Oh, that's a, oh man.

[00:26:23] It's, it's amazing.

[00:26:24] Yeah.

[00:26:25] You look through that and you'll, it's, it's crazy.

[00:26:26] It's, it's fun.

[00:26:27] It's really fun.

[00:26:28] It is really fun.

[00:26:29] I love lab day and it would be worthwhile.

[00:26:31] There's some amazing lectures.

[00:26:32] Yeah.

[00:26:32] I mean, they're teaching ceramics, which is maybe unapplicable, but you want to see some

[00:26:35] beautiful artistry.

[00:26:37] Good way to, good way to probably be in contact with the people that you're working with too.

[00:26:41] Like, like go.

[00:26:42] Or meet them there.

[00:26:43] And, and, you know, go, go to this candy store together, you know, and dream together.

[00:26:48] And, you know, that's, that's a good point.

[00:26:50] It's a good point.

[00:26:51] So I wrote down a couple of questions while we were, while we were listening to your lecture.

[00:26:55] I have to say, um, I got some good ones too.

[00:26:58] So you were, I want to talk a little bit about bridges just in general, because there's a certain,

[00:27:04] okay.

[00:27:05] Continuing education now to me seems like, I can't wait to get your take on this.

[00:27:10] Cause I have, I've got feelings about this.

[00:27:12] Okay.

[00:27:12] So implant education is so widespread that I think that maybe dentists are being taught

[00:27:21] to just an unrestorable tooth is different now than it was 20 years ago, because a tooth

[00:27:27] that's, that would be restorable, but not to bother, let's put an implant in there because

[00:27:31] it's so easy because of, and they're real implant, like teeth are just a placeholder

[00:27:37] for implants, that sort of thing.

[00:27:38] There's a lot, there, there's a, there's a, a, a thought process that goes in there.

[00:27:43] There's like a school of thought.

[00:27:44] That's like, it's implants are the solution to the problem.

[00:27:46] And I, I mean, clearly you lectured at implants all day today, but, but what I saw was that

[00:27:53] you, you found some places for bridges that, that, uh, that a lot of people, I'm into a

[00:27:57] bridge there and that's standard of care is an implant, that sort of thing.

[00:28:00] I mean, I wrote something and I said, tell me, tell me about choosing an ugly implant

[00:28:06] or a nice looking bridge in the anterior.

[00:28:09] Well, let's talk, let's first talk about something you said about, um, and I don't know how you

[00:28:13] feel about this, but should we try to save a tooth at all costs?

[00:28:15] I think absolutely right.

[00:28:16] Yeah.

[00:28:17] Personally, because every time I treatment plan my patient, it's like, okay, that's

[00:28:20] my mouth.

[00:28:21] Yeah.

[00:28:21] I'm looking in the mirror.

[00:28:22] I'm looking at my own radiographs.

[00:28:23] Would I would rather try to put a post and save that tooth?

[00:28:26] Done right.

[00:28:26] I would.

[00:28:26] Yeah.

[00:28:26] I love saving teeth.

[00:28:27] So I do everything I can, but at the same time, I'm realistic that if it's got to be,

[00:28:32] it's a third retreat, it's got an apical acid.

[00:28:35] Yeah.

[00:28:35] It's got a fracture.

[00:28:36] I get that.

[00:28:38] I think it'd be a little cheaper.

[00:28:40] So, you know, the question of a bridge in an implant, my first choice is typically an

[00:28:44] implant, but that's only if I can get the aesthetic result.

[00:28:46] Yeah.

[00:28:46] The nice thing about bridges, I can always get a great aesthetic result.

[00:28:49] That's something that people, I honest to God, I think younger folks don't realize that.

[00:28:53] Like, there was a time that implants in aesthetic dentistry wasn't a real thing.

[00:28:58] Like, it wasn't, like, they didn't have implants as an option.

[00:29:02] So they got pretty good at making nice looking teeth and missing teeth with crown and bridge

[00:29:06] work.

[00:29:07] And some of that stuff is, you know, with the materials we have now, it's even easier

[00:29:10] on some cases.

[00:29:12] Oh, I totally agree.

[00:29:12] And it used to be, you know, prior to what I think we're doing now with our implants and

[00:29:17] the CBCT and guided surgery and some of the stuff I share today, really looking at the

[00:29:21] materials to maximize aesthetics.

[00:29:22] You know, a patient coming in, if they're missing a front tooth, it's a one of my options.

[00:29:26] I'd say any implant or a bridge.

[00:29:27] And they would say, well, which one would you go with?

[00:29:29] And I would say, smile.

[00:29:31] If they had a high smile line, I'd say, if it was me, it would be a bridge.

[00:29:33] Bridge, yeah.

[00:29:34] Because I know I can get a great response with a bridge, right?

[00:29:36] Yes.

[00:29:37] And implant was kind of a crapshoot.

[00:29:38] Yeah.

[00:29:39] Right?

[00:29:39] And today, I think when planned properly, again, these are the things I shared today.

[00:29:43] When planned properly, an implant is a great option.

[00:29:45] If it's not planned properly, it's a catastrophe.

[00:29:48] Yeah, it is.

[00:29:49] Aesthetically, it's a catastrophe.

[00:29:50] Yeah.

[00:29:51] And I think the person that does not want to take the time to really plan it and nurture

[00:29:56] the tissue, especially throughout that process, is better off doing a bridge.

[00:29:59] Yeah.

[00:30:00] Yeah.

[00:30:00] Right?

[00:30:01] Yeah.

[00:30:01] I mean, guys, I guess I told you, the very first CE I took out of dental school was here

[00:30:06] in this room in 1997.

[00:30:07] 1997, September, it was Frank Spear.

[00:30:09] It was the first time I ever saw someone create an ovate ponic form where there was not a tooth,

[00:30:13] like on a long-term healed spot.

[00:30:15] And he took a big-ass football diamond and went right into it.

[00:30:20] He created with bridge temporaries this beautiful ovate ponic form by drilling right into the

[00:30:26] tissue.

[00:30:26] And I'm like, literally, I just got out of dental school.

[00:30:28] I'm like, this is how dentistry is?

[00:30:29] You can do that?

[00:30:30] You can do that?

[00:30:31] When you think about that, you're like, I mean, yes.

[00:30:34] There's, so it's not always, implants clearly are the best solution, a single tooth fix for

[00:30:40] a single tooth problem.

[00:30:41] That's really, but in a lot of cases, particularly, the other thing is, is, you know, patients already

[00:30:44] had a bridge for a long time and the teeth are holding up, but they've just, whatever,

[00:30:48] something has failed.

[00:30:49] It's, you know, it's, it's not a bad option.

[00:30:51] I totally agree with you.

[00:30:53] And like I said, I think if you're going to practice mediocrity, which unfortunately I

[00:30:58] hate to say is because I'm a dentist, there's a lot of mediocrity going on dentistry right

[00:31:02] now.

[00:31:02] You're going to have a more successful result doing crown and bridge or bridge versus an

[00:31:07] implant.

[00:31:08] If you practice with mediocrity.

[00:31:11] Yeah, no, I get it.

[00:31:12] I get it.

[00:31:13] It's, there's, there's a, getting the result you're looking for is definitely harder with,

[00:31:17] with an implant, particularly if the tissue's a challenge or whatever, like you're saying,

[00:31:20] but I don't know.

[00:31:21] I just, sometimes I think the way a lot of continuing education is now, it's just like

[00:31:26] implants are everything.

[00:31:27] And there's, you know, there's no reason when I, when someone says you should never do a

[00:31:30] bridge, why would you ever do a bridge?

[00:31:31] I'm like, well, there's actually that there's a fair amount of shades of gray in here.

[00:31:36] Clearly implants are a really great solution, but you gotta, you gotta know what you can't,

[00:31:41] like you said, options are cool, man.

[00:31:42] It's nice to be able to do a lot of different things.

[00:31:44] You know, it's a, that's David's literally his first line was talking about how, how having

[00:31:48] options is cool.

[00:31:50] Options are cool.

[00:31:50] Yep.

[00:31:51] Options are cool.

[00:31:52] And again, I'm glad you brought that up because I think a lot of people say, I'll just

[00:31:56] put an implant, just put an implant, just put an implant.

[00:31:59] And implant requires planning.

[00:32:01] And you know, there's a lot of patients you can't, whether it's a, you know, a fossil

[00:32:06] mass or a smoker or they don't have enough bone.

[00:32:09] And I see a lot of dentistry being done where there's not enough bone.

[00:32:12] They're putting an implant just because they want an implant.

[00:32:14] It's like, what am I going to do with that now?

[00:32:16] Yeah.

[00:32:16] Like that case I showed you those two implants.

[00:32:18] What am I going to do with those two implants?

[00:32:19] Oh my gosh.

[00:32:20] Yeah.

[00:32:20] You know, something along those lines though, too.

[00:32:24] I, I, um, you were talking about interior.

[00:32:27] First off, like, like you, you were asking about people who had failures with zirconia

[00:32:30] bridges.

[00:32:31] We were talking about, okay, you really can get away from metal if you want to.

[00:32:34] And, and one of the things you talked about is how, when you had failures in zirconia,

[00:32:39] typically it's in the connector where they've got, they've got like kind of heavy embrasures.

[00:32:44] And so you're thinning that connector and that's where it breaks almost every time.

[00:32:47] So you, you talked about a technique, particularly in the interior where, um, you don't need to

[00:32:53] have lingual embrasures really on it.

[00:32:56] Particularly in the interior like that, you don't need to.

[00:32:57] The difference is patient, it feels weird to a patient.

[00:32:59] So you were suggesting fill in any lingual embrasures in the provision, let them wear

[00:33:04] it for a while.

[00:33:05] So they're used to that no lingual embrasures with their tongue.

[00:33:08] So when you give them their, their bridge, that's going to be super sturdy because they're

[00:33:11] having put that anatomy in on the lingual.

[00:33:13] That's going to weaken it.

[00:33:15] I'd never heard that.

[00:33:16] It makes perfect sense.

[00:33:17] And I literally have like three cases in the last year.

[00:33:19] I wish I had done it because that was what we ended up having to do.

[00:33:21] I'm like, it feels weird.

[00:33:22] You'll get used to it, but you'd rather say that when you're giving them a temporary than

[00:33:26] when you're giving them the final one after they've paid a bunch of money.

[00:33:29] Yeah.

[00:33:29] And then you submit it and they say, this doesn't feel good.

[00:33:31] Yeah.

[00:33:32] And you know, everything I shared today, and that's a good example is based on my own

[00:33:36] world life experiences, you know, where the, where the patient said, this isn't going

[00:33:40] to work.

[00:33:40] It's like, well, we had to do it that way.

[00:33:42] Yeah.

[00:33:42] And I thought, how can I make the temporary is a little bulkier.

[00:33:45] Yeah.

[00:33:46] So that's just in the interior.

[00:33:48] Yeah.

[00:33:48] If they can't tolerate, then we change materials.

[00:33:50] Yeah.

[00:33:51] No, it's, it's a trick that literally, I kind of want to say that again, because the listeners,

[00:33:54] if you're in the car and you, if you make your embrasures on bridge temporaries a little

[00:33:59] on the, particularly on the side that doesn't show, fill them in.

[00:34:02] Cause they're not, that is a, um, that's a dentist thing where we get hung up on, on anatomy.

[00:34:07] And I'm like, that's not an anatomical feature.

[00:34:09] That's particularly necessary, especially when you can make the materials that we're using

[00:34:13] much better for it.

[00:34:14] Well, the example, I, maybe we set ourselves up to make sure they truly understand patient

[00:34:18] comes in, it's got a PFM bridge from eight to 10, right?

[00:34:21] So it's got metal.

[00:34:21] So it's got facial embrasures and lingual embrasures pretty distinctive, right?

[00:34:26] And the patient's used to that.

[00:34:27] Yeah.

[00:34:27] The bridge is ugly cause it's a PFM.

[00:34:29] So you take an anterior triple tray first and you take a polyvinyl of the preexisting

[00:34:34] bridge and you cut off the bridge and then you put your temporary and the temporary is the

[00:34:38] exact same shape with nice lingual embrasures like your PFM.

[00:34:41] And then you get the zirconia back or it could be Emax, it could be Lisi press.

[00:34:46] And there's not much of a lingual embrasure.

[00:34:48] The patient says it feels bulky.

[00:34:49] Right.

[00:34:50] And that's happened to me on enough occasions.

[00:34:52] It's like, dude, I got to fit.

[00:34:54] I got to do something different.

[00:34:55] So we just in the Lexitem preventative, we just fill in the lingual embrasure until the

[00:34:58] patient, listen, this is how it's going to be.

[00:35:00] Mm-hmm.

[00:35:01] And I mean, patients, well, the story is that your nervous system can get used to almost

[00:35:05] anything as long as, and if someone, if Dr. Hornbrook tells me I can get used to it,

[00:35:09] I can probably get used to it.

[00:35:10] But like if you can do it in your temporary, it's a lot easier.

[00:35:12] Yeah.

[00:35:13] A lot easier.

[00:35:13] Final one.

[00:35:14] Yeah.

[00:35:14] It was a really good point.

[00:35:16] I'm like, man, I've never thought of that even though it makes perfect sense to

[00:35:18] me.

[00:35:19] Especially if you haven't finished their payment on the day it's.

[00:35:23] That's right.

[00:35:24] Because now they say, this doesn't feel so good.

[00:35:26] I don't know if I want to pay the balance.

[00:35:27] Exactly.

[00:35:27] Right?

[00:35:27] No, exactly.

[00:35:28] Okay.

[00:35:29] So like the thing about it is, is that David is clearly, everyone has heard of David.

[00:35:33] He's been, you've been on the lecture circuit for, I mean, I know you've been around for,

[00:35:37] for since, since I graduated from dental school.

[00:35:39] When did you, when did you start?

[00:35:40] When was your first lecture?

[00:35:41] My first lecture was in 1988.

[00:35:43] It's kind of funny.

[00:35:44] Um, so it was called porcelain inlays, onlays and veneers.

[00:35:48] And the impetus for that was I actually saw John Sorensen speak on inlays and onlays

[00:35:53] in UCLA.

[00:35:54] And so I went with a friend of mine, Steve Corey and John's a great dentist and he showed

[00:35:59] beautiful cases and he had so much research.

[00:36:01] He's a pop, a prosthodontist had so much research.

[00:36:04] And the end of the day, I turned to Steve and I said, could you do one of these?

[00:36:06] He says, no, because there was no like recipe.

[00:36:11] Yeah.

[00:36:11] Yeah.

[00:36:11] I mean, it was, yeah, they, they look good and, and, and there's data on this and these

[00:36:14] are the materials.

[00:36:15] And I thought that this isn't right.

[00:36:16] And I'm a simple thinker, you know, I've been sharing that from the beginning.

[00:36:19] I'm a systems thinker.

[00:36:20] So I thought, you know what?

[00:36:21] There's a lot of dentists that want to do this.

[00:36:23] Um, and I kind of have the research now.

[00:36:26] Let me just put a recipe.

[00:36:27] You know, this is where you start and this is where you end.

[00:36:29] Right.

[00:36:30] So, um, I thought this is me.

[00:36:33] And I mentioned again, the thing I'm kind of an idiot savant with dental materials.

[00:36:37] I can't remember crap with anything else.

[00:36:39] You know, it's a good problem to have when you're a dentist.

[00:36:41] Yeah, probably.

[00:36:43] But I can't remember lyrics to saw.

[00:36:45] I can't remember names, anything.

[00:36:46] Right.

[00:36:47] But dental materials are weird.

[00:36:48] So I thought, you know what?

[00:36:50] My first lecture, there's going to be a bunch of people that are older than me.

[00:36:52] You know, I had long hair and I was 26 years old.

[00:36:55] Yeah.

[00:36:56] And, um, I said, they're going to ask me questions.

[00:36:59] I've got to make sure I'm the smartest kid in the room.

[00:37:01] Yeah.

[00:37:01] Right.

[00:37:01] Yeah.

[00:37:01] So I memorized literally every cement and adhesive on the market, including percent, percentage

[00:37:08] weight by volume of particle size in each of the resins.

[00:37:12] Like, what if someone asked me, you know, what's the, what's the particle resin, you know, percentage

[00:37:15] in this particular cement?

[00:37:16] Of course, no one asked me those questions.

[00:37:18] But how, oh my God, you probably wish they had to come back when you'd look so cool.

[00:37:22] So it's, uh, it was kind of funny, but, uh, so I'll tell you, I kind of another funny story.

[00:37:27] So after that, there's about 75 people.

[00:37:29] And I thought, you know, this would be kind of cool to cut, just start a study club.

[00:37:33] I mean, this is the late eighties and we didn't really have much mentorship in aesthetics.

[00:37:36] Bob Nixon was speaking on veneers.

[00:37:38] That was about it.

[00:37:38] By the way, Bob Nixon, I saw him at the Veter's Society.

[00:37:41] Oh yeah.

[00:37:41] He's great.

[00:37:42] In the early 2000s.

[00:37:44] And a lot of your listeners never heard of him.

[00:37:45] Yeah.

[00:37:45] You should Google him.

[00:37:47] He was, he's, he's veneers basically.

[00:37:49] If you do a veneer, you got to thank Bob Nixon.

[00:37:51] He's the first person that wrote all the books and was doing all the lectures.

[00:37:54] So anyway, I, you'll appreciate this.

[00:37:57] Um, so I thought, you know, we need a study club and I think this would be kind of fun.

[00:38:01] Right.

[00:38:01] And so I had a list on the front.

[00:38:02] I said, you know, whoever would be interested in the study club, put your name, you know,

[00:38:06] here and, and email address and we'll start it up.

[00:38:09] Right.

[00:38:10] So I was shooting pool the next couple of days and with my friend Nelson, who I went

[00:38:14] to school with.

[00:38:15] And I said, you know, what should we call it?

[00:38:17] He said, well, how about like San Diego aesthetic study club?

[00:38:19] And I said, why don't we think bigger?

[00:38:20] Let's call it the Pacific Academy of aesthetic dentistry.

[00:38:23] At one time we had 650 members.

[00:38:26] So I thought, you know, our first meeting, so this is about Thanksgiving.

[00:38:29] We're shooting pool.

[00:38:31] And I said, let's have a meeting and let's, let's eliminate all hurdles and obstacles.

[00:38:35] Right.

[00:38:36] So let's, we can't have it during weekday because people have to work.

[00:38:40] Can't really have it on a Saturday because that's like the first day of the week with

[00:38:44] family day, Sunday mornings church.

[00:38:46] So how about Sunday afternoon?

[00:38:47] There's no really excuse why you can't go to like a four hours on Sunday afternoon.

[00:38:50] Right.

[00:38:50] So I call this hotel, Hanalei hotel in San Diego.

[00:38:53] And I said, you know, oh, and I said, you know, we can't have it for Christmas because

[00:38:56] people are thinking about things.

[00:38:57] Right.

[00:38:57] And right after Christmas, they'll forget about it during the holidays and they won't

[00:39:01] show up.

[00:39:01] So why don't we have it like three weeks after the first year gives them a chance to, to get

[00:39:05] back into it.

[00:39:06] I can market it through pattern through Patterson and shine.

[00:39:11] I will have a great turnout.

[00:39:12] Right.

[00:39:12] So I call the hotel and I'd say, you know, I'm looking for like a ballroom on Saturday afternoon.

[00:39:18] And when it like January 21st, I said, is it available?

[00:39:22] Any chance?

[00:39:22] Oh yeah, definitely available.

[00:39:24] And I thought, well, that's good.

[00:39:25] That was easy.

[00:39:26] Right.

[00:39:26] So I have to left a deposit.

[00:39:27] Right.

[00:39:27] We're getting closer and closer and closer and I'm getting all excited about it.

[00:39:31] I'm getting all these registrations in.

[00:39:32] Well, it turned out the reason it was available.

[00:39:35] That was Superbowl Sunday.

[00:39:39] And the Superbowl started at one, the same time my lecture, we had 75 people there.

[00:39:44] Yeah.

[00:39:45] And that's pretty good.

[00:39:46] And every once in a while, someone would run to the bar and say, sure.

[00:39:48] Green Bay is winning.

[00:39:49] Yeah.

[00:39:50] Yeah.

[00:39:50] Yeah.

[00:39:50] But I thought, holy cow.

[00:39:52] I mean, this is, this is the kind of, of knowledge.

[00:39:54] These people were dying to learn.

[00:39:56] That's excellent.

[00:39:57] And I brought guest speakers in.

[00:39:57] I had a newsletter and we had over 650 people on the newsletter at one time.

[00:40:01] And so that's kind of how I started early eighties.

[00:40:04] Yeah.

[00:40:05] You know, I started LVI with Bill Dickerson in 94.

[00:40:08] You know, Rich Rosenblatt started a study club in Chicago in a similar way.

[00:40:11] I wonder if, I wonder if he'd heard your story before this, because you sort of started out

[00:40:14] a whole cloth basically like, well, we need this.

[00:40:16] Let's do this.

[00:40:17] I mean, that's, and that's kind of what Rich did too.

[00:40:19] So part of reason too, is I had a friend of mine that was a dentist and she said, I'm going

[00:40:24] to do this porcelain inlay.

[00:40:25] So she was using stuff from gold and applying to porcelain.

[00:40:29] She says, I did an IRM buildup to ideal and then put Copalite and bonded.

[00:40:33] And I said, excuse me, I don't think you can do that.

[00:40:36] And she was a really good dentist.

[00:40:37] And I thought, you know, these people don't really have the knowledge to take their dentistry,

[00:40:44] to use their skills to the advantage.

[00:40:46] And I thought, you know, someone needs to educate them.

[00:40:48] And I thought maybe that's kind of like my job.

[00:40:50] Meanwhile, you started literally right at the kind of where, where the cosmetic dentistry

[00:40:55] revolution took over.

[00:40:56] Literally when people talk about the cosmetic, they think of you and Bill Dickerson in a lot

[00:41:00] of cases.

[00:41:01] That's sort of, so you were in the right place at the right time.

[00:41:02] I was.

[00:41:03] Did you have aspirations when you're in dental school to be someone who lectured in front

[00:41:06] of people or not necessarily?

[00:41:07] No.

[00:41:07] I was bored out of my mind at dental school.

[00:41:09] You know, I shared the story, you know, had nothing to do with creativity or artistry.

[00:41:13] You know, you were a technician.

[00:41:14] You had to match that.

[00:41:15] They told you what to do and do it.

[00:41:16] Right.

[00:41:16] Your prep had to look like this.

[00:41:17] If it was different, you flunked it.

[00:41:19] It didn't matter how pretty it was.

[00:41:21] You flunked if it wasn't exactly what everyone else's look like.

[00:41:24] And I thought this isn't for me.

[00:41:25] And so I got out and I had a really unusual experience in, in between my freshman and sophomore

[00:41:32] year of dental school, Horace Kohlzer, who really was one of the first aesthetic companies.

[00:41:36] They had Durafil and they had Durafil color, which are these modifiers.

[00:41:39] Yeah.

[00:41:39] Yeah.

[00:41:40] And it was brand new.

[00:41:41] And they had this program that, you know, having sales reps, they were hard to get into dental

[00:41:45] offices.

[00:41:46] Why don't they just hire these dental students between the first and second year?

[00:41:49] Because these dental students could go in and say, oh, I'm just a dentist.

[00:41:52] And I did that for a summer.

[00:41:53] Right.

[00:41:53] Yeah.

[00:41:54] And, you know, the first year of dental school, you don't learn anything about dentistry.

[00:41:57] So I was going in and telling these, these doctors, oh, you can use this for a class one,

[00:42:00] class two.

[00:42:01] I didn't even know what those were.

[00:42:02] You know what he was talking about?

[00:42:02] I had no idea what they were.

[00:42:04] But then I see about, they'd say, no, the doctor doesn't see sales reps.

[00:42:07] And I'd say, you know what?

[00:42:08] I'm really a dental student.

[00:42:10] Yeah.

[00:42:10] I just have, I just want to, I just like, can I observe him for half hour?

[00:42:13] And then the dentist would feel sorry for me and buy whatever little crap I had.

[00:42:18] Right.

[00:42:18] And so then I got back.

[00:42:19] And the one thing that, that Coles, Coles let us do was keep our grip stock.

[00:42:23] Yeah.

[00:42:23] Which means I came back on my second year when everyone's given like one shade of Herculine.

[00:42:27] Yeah.

[00:42:27] I had all this cool stuff that the instructors had never seen.

[00:42:30] Oh, that's really cool.

[00:42:31] And so they allowed me to do some of this direct, some of this teaching, this direct deposit

[00:42:36] stuff.

[00:42:36] So I had all this stuff that they didn't.

[00:42:38] That's awesome.

[00:42:38] But I never envisioned that I would do be educating.

[00:42:42] I just want to do something that was artistic and creative.

[00:42:44] And then it just, it just snowballed.

[00:42:46] You know, when I started, when I did that one lecture, someone in the audience was from

[00:42:50] another study club and said, Hey, you lectured for two hours.

[00:42:53] Do you think you'd give a four hour lecture?

[00:42:55] And I said, Oh yeah, I'd love that.

[00:42:56] You know, and I got back and I thought, what the hell am I going to talk about for four

[00:42:59] hours?

[00:43:00] You know, and then I found enough stuff.

[00:43:02] My photography sucked and it was all slides.

[00:43:04] Yeah.

[00:43:05] And, you know, I used to make my title slides by typing on a white piece of paper.

[00:43:08] Of course you did.

[00:43:09] Taking out to the, out to the sun, taking a photo of that.

[00:43:12] Yeah.

[00:43:13] And then making the slide and having to take multiple photos of cases because you realize

[00:43:17] you missed something or your flash didn't go off on a certain time.

[00:43:21] Yeah.

[00:43:22] And so, you know, then I would do a four hour lecture and someone from the state meeting

[00:43:25] would say, Hey, is there any way you could do, you know, eight hours all day?

[00:43:28] And I said, Oh, I'd love to do that.

[00:43:29] And then it's like, what the hell am I going to talk about for eight hours?

[00:43:31] The recipe to being an expert is have a big slide deck and be from an hour away.

[00:43:39] That's how you become the speaker, right?

[00:43:40] That's right.

[00:43:41] So 300 miles.

[00:43:42] Yeah.

[00:43:43] That's a good limit.

[00:43:44] Really.

[00:43:44] You become more expert the further away you are.

[00:43:46] So it was funny, something that I was going to ask you, I thought about it today and it's,

[00:43:50] it's obnoxious, but I guess I'm going for it.

[00:43:52] Cause like your photography is excellent, but your photography is also, here's what I'm going

[00:43:57] to say.

[00:43:58] Okay.

[00:43:58] So you said in the very beginning yesterday, you typically use a ring flash and then you

[00:44:02] also have the, you have the, the polarized for that.

[00:44:06] And I have the same source, but for younger listeners.

[00:44:10] Who, who follow Instagram dental porn?

[00:44:13] Uh, like your photography is excellent, but it's not the soft box, crazy, sexy, wild and

[00:44:22] crazy.

[00:44:22] It's yours is good clinical photography that would, you know, I suspect a lot of it's used

[00:44:26] for lab, letting your lab know what you want to do.

[00:44:29] And you know, like your patients have calculus in some cases on their lower anteriors when

[00:44:33] you're working on the upper and you're like, I can tell your patients are actual people.

[00:44:37] And then you also didn't, you know, you didn't have one case for the day that you spent the

[00:44:40] entire day photographing and all that.

[00:44:42] And, and you didn't use the crazy soft boxes and you didn't have them biting on fruit in a

[00:44:46] funny angle or anything like that.

[00:44:47] Your photography is excellent, but it's also, it's the kind of photography that I think

[00:44:50] if I work on it, I could do, you know what I'm saying?

[00:44:52] And I think it's really important if you've not seen David speak, you need to, because

[00:44:57] I mean, I've seen a lot of really good speakers, but I also am like, you know, I can't do that.

[00:45:01] Right.

[00:45:02] I can't do that because I see patients, you know, like I can't really, like I might aspire

[00:45:08] to that, but I can't really do that.

[00:45:10] And I, what I loved is like, this is photography and this is dentistry that I can see doing,

[00:45:15] or at least having a shot at doing.

[00:45:17] Right.

[00:45:18] You know, it's not like every slide you showed was a full mouth rehab from start to finish

[00:45:22] with soft boxes.

[00:45:23] That's what we're talking about tomorrow.

[00:45:24] Not soft boxes.

[00:45:25] Definitely not soft boxes.

[00:45:26] But I mean, like I actually, I said this to a bunch of my friends.

[00:45:29] I'm like, how great would it be to do an Instagram troll account that was all like super high

[00:45:36] end soft box photography of absolutely shitty dentistry.

[00:45:39] Like, like, like fillings with recurrent decay, like pre-op awful meth mouth kind of stuff.

[00:45:45] But like with the super high, I think that'd be the funniest thing in the entire world.

[00:45:48] And now I've blown it because I would have never had the discipline to actually do it.

[00:45:52] But I mean, there's some amazing photographers out there, but it's also like, that's not

[00:45:55] what most patients will do.

[00:45:57] And that's not what I can do.

[00:45:58] Well, the other thing too, it's not realistic.

[00:45:59] Yeah.

[00:46:00] You know, you see these soft boxes, double soft boxes for these smiles.

[00:46:03] They don't look like teeth.

[00:46:04] I mean, that's not when you look at a smile.

[00:46:05] It looks like a freaking painting or something.

[00:46:06] It's amazing to look at, but it's not.

[00:46:08] Yeah.

[00:46:08] I don't even know that it gives the detail you need.

[00:46:10] No, I don't think it does either.

[00:46:11] And it's, and you remember when they used to have the glamour shots in the mall, you know,

[00:46:14] and they would make, you know, the ugliest girl in class look like a freaking movie star

[00:46:18] and they'd make even me look good.

[00:46:19] And it's like, you know, it's like putting nylon, you know, over the camera and it made

[00:46:23] the skin perfect and the hair, everything was freaking perfect.

[00:46:26] But you realize that that's not who that person doesn't look like that person at all.

[00:46:30] Yeah.

[00:46:30] And I think a lot of this photography is they spend more time on their photography.

[00:46:36] It's novelty photography on some level.

[00:46:38] And I, I give them credit for it.

[00:46:40] And there's a part of me that wishes I could do that.

[00:46:42] But I'm also like, I've seen some of their setups.

[00:46:44] They got, they'll have the crazy, like, like they literally have employees that hold the

[00:46:49] softbox in a shirt.

[00:46:49] Like that's how much of this they do.

[00:46:51] I'm like, I can't do that.

[00:46:52] You know, everything.

[00:46:53] So I'm, you know, I have a practice, right?

[00:46:55] So I'm seeing patients all day.

[00:46:56] He really does.

[00:46:57] He showed us pictures and everything.

[00:46:58] He really does have a practice.

[00:46:59] I've got hygiene checks.

[00:47:00] You know, I've got all that.

[00:47:02] And I manage the practice.

[00:47:03] All those pictures were taken just as I'm doing the case.

[00:47:07] You know, all of a sudden I just have my camera there.

[00:47:09] I say, shoot, this is a cool thing.

[00:47:10] So do you take most of your photos?

[00:47:12] I take all my own photos.

[00:47:12] Okay.

[00:47:13] So your assistant isn't necessarily doing, they're probably retracting or doing whatever.

[00:47:15] Yeah.

[00:47:16] It's because I like it, you know, and, and it's important to me to get good photography

[00:47:20] that, that is educational, but also provides information on my ceramics.

[00:47:24] For someone, for someone who has the camera and has the, has taken the courses and just hasn't

[00:47:29] really, hasn't really incorporate, what's the best tip to say, okay, how do you do it

[00:47:33] so you make it a part of the, is it, is it just literally having it close enough that you've

[00:47:37] grabbed it.

[00:47:38] I mean, it's literally that.

[00:47:39] First of all, one is having a system and understanding how to use it.

[00:47:42] And there's lots of resources for that.

[00:47:43] We can go to YouTube for that.

[00:47:44] But it's like anything, if it's close by, you're going to use it.

[00:47:46] You know, anytime I have a restorative case, if I've got to go, you know, it's like any,

[00:47:52] I mean, you're busy, right?

[00:47:53] And you've got to get things done and there's a cool thing, but you know, your SDI card is

[00:47:58] in your computer.

[00:48:02] Yes.

[00:48:02] The best is the one time I get it out there to take the photos.

[00:48:04] I take a couple of really good photos and I realize after that, I didn't have a fucking

[00:48:07] card.

[00:48:08] It didn't have a card.

[00:48:08] It didn't have a card.

[00:48:09] Yeah.

[00:48:09] I've done that.

[00:48:09] That's right.

[00:48:10] There's a setting on your camera that will not let you take that.

[00:48:12] I know.

[00:48:12] I know.

[00:48:13] No card.

[00:48:13] Oh my God.

[00:48:14] It says, because leave me, I've done that enough too.

[00:48:15] So, you know, it's like anything that becomes part of the tray setup almost, you know,

[00:48:20] it's sitting right there.

[00:48:21] Sometimes I use it, sometimes I don't.

[00:48:22] I use it on all my prep cases, you know, for shade.

[00:48:26] Sure.

[00:48:26] It's just cool to just to be able, you know, a lot of stuff I take, unless you want to lecture,

[00:48:30] it's useless.

[00:48:31] Yeah.

[00:48:31] You know, if you're showing how to block some things out, you know, unless you ever wanted

[00:48:35] to show somebody, but you know, I just like it there, like anything.

[00:48:39] I'm not going to lie to you.

[00:48:40] When you say, I know what you're saying, because a lot of times when you're taking photography

[00:48:43] or lectures, that's good.

[00:48:44] But also just like with 3D imaging and, you know, like your scanner, you blow your teeth

[00:48:50] up to that though that you're working on.

[00:48:52] But first off, you're going to be critical of yourself in a good way, in a good way.

[00:48:55] You're going to see this stuff because I don't care what kind of magnification you're using.

[00:48:58] You don't see it like that.

[00:48:59] I mean, like, I mean, the intraoral scanner is unforgiving.

[00:49:04] Whatever ugliness is in your prep, you're going to see it as big as life.

[00:49:06] Smooth prep looks like you used a hack.

[00:49:08] Exactly.

[00:49:08] Exactly.

[00:49:09] I think photography has a way of doing that too.

[00:49:11] Like when was the last time you put a case in, took after photos and you didn't think,

[00:49:15] oh God, I could have done this.

[00:49:16] Well, you know, it all started with, you know, the American Academy of Cosmetic Dentistry when we were

[00:49:19] getting our accreditation.

[00:49:21] And again, those were slides.

[00:49:22] And you'd have exact slides.

[00:49:25] Yeah.

[00:49:25] And if you forget when you screw up, but you know, it's eyeopening when you put a, you know,

[00:49:30] one-to-one shot on a screen, a six by six screen.

[00:49:32] And you think, I thought that case was perfect.

[00:49:35] Perfect.

[00:49:35] And it's not perfect.

[00:49:36] Yeah.

[00:49:37] There's an open gingival embrasure.

[00:49:38] There's tissue that's a little inflamed.

[00:49:40] And you know, if you start seeing your stuff and want to get better, then it becomes habit.

[00:49:44] And you think, okay, next time it's going to be better.

[00:49:45] This is going to be the case.

[00:49:46] You know, that's going to be my perfect case.

[00:49:48] And then it's not.

[00:49:49] And then your next case is not.

[00:49:51] But pretty soon, you know, your bar has been raised where what you'll accept and your goals are higher.

[00:49:58] And it's really powerful to be able to do that.

[00:50:00] You know, we see that on the computer screen and we see that in Instagram, you know, you don't know what is Photoshopped and what's not.

[00:50:06] But at the same time, you can see some beautiful dentistry and something to aspire.

[00:50:10] But, you know, you brought up a really good point.

[00:50:12] The real, you've got to be realistic.

[00:50:14] If, you know, I had a friend that lectured and he did all his cosmetic cases on a day that he was off so he could photograph because he had a busy practice.

[00:50:22] That's not very realistic for most people.

[00:50:24] You know, you and I both have families.

[00:50:26] We'd rather be home doing something.

[00:50:27] Yeah.

[00:50:27] Yeah.

[00:50:28] Than doing a case on our day off just so we could photograph it.

[00:50:31] Yeah.

[00:50:31] I understand why you would do that.

[00:50:34] But on some level, like dentists like me pay good money to go to courses.

[00:50:39] And if you're not really showing how things can be done, we're going to have an unrealistic expectation about what we can do.

[00:50:45] Like, you know, and I think that people just have to understand that that's kind of how it goes.

[00:50:49] It's not.

[00:50:50] It isn't a deal breaker, but it is.

[00:50:52] I appreciated.

[00:50:53] I'm not to say that your dentistry isn't amazing and your photography is fantastic, but it struck me as more realistic for someone like me to be able to do some of these things.

[00:51:03] If you haven't seen.

[00:51:04] I don't know if I need to take that as a compliment or.

[00:51:06] No, it's.

[00:51:07] I don't mean it as an insult at all.

[00:51:09] What I'm saying, though, is like, well, what I can't do is, you know, like some of the stuff that.

[00:51:14] I don't know.

[00:51:15] Some of the classic.

[00:51:16] Oh, some of the teaching cases they use at Spear.

[00:51:18] And of course, I've been using the same cases a lot of times.

[00:51:20] You're like, I never would have thought to do it that way.

[00:51:23] And that's actually the point of it.

[00:51:24] Well, that they're giving you a different way to look at it.

[00:51:26] But there's just a lot of stuff that.

[00:51:28] A lot of stuff, too, is, you know, they put the patient three years in ortho to bring down a root.

[00:51:32] Yeah.

[00:51:32] It's like my patient would say, I just want to do this.

[00:51:34] Yeah.

[00:51:35] You can't hate him for doing that.

[00:51:37] But also, it's like, I don't know that.

[00:51:38] And you shouldn't feel bad that you can't get your patients to do that necessarily.

[00:51:42] It's pretty important that you know you can do that.

[00:51:43] But it isn't that it's a failure if you didn't do that.

[00:51:47] Like, you know, compromised cases are not always horrible.

[00:51:50] And, you know, because there's a person attached to this thing.

[00:51:53] And there's realistic expectations.

[00:51:56] And one of those expectations is time.

[00:51:58] You know, like a lot of the cases we do in our instant orthodontic cases.

[00:52:01] Yeah, maybe Invisalign first and conservative veneers with this patient.

[00:52:04] No, I'm not going to wait 10 more months.

[00:52:06] You know, if you need to prep a little more teeth away, I'm fine with that.

[00:52:09] Because one of my expectations is I want a new smile like now.

[00:52:13] One other thing I want to talk about is that way.

[00:52:15] There's, I mean, there's a lot of minimally invasive.

[00:52:20] That's not even the word I want to use.

[00:52:21] So basically the preservation of tooth structure as a way of life, which I get it.

[00:52:27] And I totally understand that.

[00:52:28] But on the other hand, you know, we've got materials that need room.

[00:52:32] If you've committed a tooth to a crown, you need to give the lab the room.

[00:52:37] In other words, don't use conservation of tooth structure.

[00:52:42] If you're going to do the crown, do it.

[00:52:44] You know, if you're good, you know what I'm talking about?

[00:52:46] And there's a lot of people that would shame you for that in some level because you're not being conservative enough.

[00:52:51] But I'm like, no offense, but that's dentists talking to dentists.

[00:52:55] Most people, if they realize they have to do a crown, I mean, you could spin it in such a way we don't want to lose that much tooth structure.

[00:53:00] But I'm like, these people are not taking that good of care of their teeth in the first place.

[00:53:03] These people lose teeth, not tooth structure.

[00:53:06] So I just.

[00:53:06] Yeah, I agree.

[00:53:07] You know, my goal is to save as much tooth structure as you can.

[00:53:10] Sure.

[00:53:10] As I mentioned, remove the bad stuff.

[00:53:12] Yeah.

[00:53:12] Optimize aesthetics, optimize function, and provide room for the material.

[00:53:16] And, you know, kind of interesting thing is because I've heard people say I would never have done veneers on that.

[00:53:20] Well, if you wouldn't, someone else would have.

[00:53:21] Yeah.

[00:53:21] And it might have not been as good a dentist as you.

[00:53:23] Yeah.

[00:53:24] And I had a case that kind of opened my eyes.

[00:53:25] There was two cases in my career early on where a patient came and had reasonably nice teeth.

[00:53:29] But in her mind, she had to have veneers.

[00:53:32] Right.

[00:53:32] I was like, no.

[00:53:32] You're in San Diego.

[00:53:33] That's more likely.

[00:53:34] Yeah.

[00:53:35] Yeah.

[00:53:35] And this was probably 20.

[00:53:36] This might have been 30 years ago.

[00:53:38] And I said, no, you don't want to grind those down.

[00:53:40] Yeah.

[00:53:41] Yeah.

[00:53:41] No, I want veneers.

[00:53:41] No, I'm not going to do veneers.

[00:53:43] Your teeth are fine.

[00:53:44] So I was making her aesthetic judgment for her.

[00:53:46] You were.

[00:53:47] Yeah.

[00:53:47] Fine.

[00:53:47] Right.

[00:53:48] And so I said, no, I'm not going to do it.

[00:53:50] And then she came back about six months later because she liked my hijabers and she had six

[00:53:54] PFMs.

[00:53:54] Oh, geez.

[00:53:55] Yeah.

[00:53:55] And I said, what was that all about?

[00:53:56] She goes, because you wouldn't do it.

[00:53:58] So she went to another dentist and said, yes.

[00:54:00] Teeth chopped down.

[00:54:00] Yeah.

[00:54:01] And instead of conservative veneers, she got PFMs and they were ugly and a lot of tooth

[00:54:05] structure was taken away.

[00:54:06] And I thought, you know, I'm kind of the person to blame for that a little bit.

[00:54:09] I have to take some blame because I told her no.

[00:54:12] And maybe I didn't educate her enough, but another case was very similar.

[00:54:16] And I thought, you know what?

[00:54:17] I should have done that because I would have used better materials.

[00:54:19] I would have used a better lab.

[00:54:20] I would have been more conservative.

[00:54:22] And so now, as long as the patient knows, even with the whole ortho thing, people say,

[00:54:26] how can we not do an ortho before all these cases?

[00:54:28] I say, well, you know, they know about it.

[00:54:31] I make sure they know.

[00:54:32] Yeah.

[00:54:32] But there's disadvantage of doing ortho first.

[00:54:34] I mean, one is money.

[00:54:35] All of a sudden, I just added five grand to your case, right?

[00:54:37] And you've been saving for time too.

[00:54:39] I mean, that's a lot of time.

[00:54:41] And retention as an adult, you know, especially males.

[00:54:43] I don't want to wear a retainer the rest of my life.

[00:54:45] Mm-hmm.

[00:54:46] It's funny because it's a lot of judgment calls from the dentist.

[00:54:50] And of course, we know so much more than a patient.

[00:54:53] Like on some level, how can a patient even make informed consent on some level?

[00:54:56] Because like literally the knowledge gap between what a dentist practicing every day knows about this stuff and a patient is like, it's unreal.

[00:55:02] I laugh because as a dentist, I could explain veneers as a very minimally invasive kind of procedure where it's, you know, we barely touch the teeth.

[00:55:13] I could also explain veneers as chopping tooth structure.

[00:55:16] Like so on some level, it's almost like healthy.

[00:55:18] Exactly.

[00:55:19] It's our own baggage that we bring to that.

[00:55:22] Of course.

[00:55:22] That's a tough thing.

[00:55:23] That's a tough thing because one person could judge that as a really nicely minimally done case.

[00:55:28] And another person could say, why would you take that tooth structure?

[00:55:31] Exactly.

[00:55:31] And I get that occasionally.

[00:55:32] And that's okay because, you know, I'm okay in the fact that it is a subjective decision.

[00:55:37] If someone doesn't want to do it, it's fine.

[00:55:39] But you can't really judge me for doing something I felt comfortable with.

[00:55:43] You know, I've heard people say, oh, you know, you removed virgin enamel.

[00:55:47] And my response always is, you know, what did a virgin ever do for you anyway?

[00:55:51] It's like, who cares if it's gone?

[00:55:53] That's right.

[00:55:53] Well, and I mean, like, I know for a fact you'd rather try and bond veneer to enamel than denton anyhow.

[00:56:00] So it's one of those things where, yeah, I don't know.

[00:56:02] That's always sort of bothered me.

[00:56:04] I mean, considering in dental school, they teach you, you know, they teach you porcelain fused to gold preparations.

[00:56:09] They're pretty aggressive, you know.

[00:56:11] It's like, I don't know.

[00:56:12] I just, that always struck me as a little hollow.

[00:56:14] And there are still, there are schools of thought that it's just like, you know, indirect restorations are destroying teeth.

[00:56:19] I'm like, I can't get there.

[00:56:20] I just can't get there.

[00:56:21] I've been doing this for too long.

[00:56:22] And there's not a right or wrong way.

[00:56:24] Yeah, I think that's right.

[00:56:25] You know, we're hoping that we're both trying to get to the top of the mountain, which means be taking different paths.

[00:56:29] There may be even a different mountain, but hopefully it's, there's a peak somewhere that makes some sense.

[00:56:34] And I think when dentists start judging other dentists based on their own thought process and philosophies, I think that's wrong because there's things that, that maybe some other dentists do that I would never, ever do.

[00:56:44] But it's working in their hands.

[00:56:46] It's right for their patients and they feel good about it.

[00:56:49] I'm going to wrap it up, but I just, I, we have a lot of listeners that are probably young, younger dentists.

[00:56:54] We have dental students, stuff like that.

[00:56:55] But knowing, you know, knowing what you know from when you were in dental school and now and knowing what you've seen, you know, with, what do you tell a new graduate about, about being a dentist?

[00:57:05] What, what, what is, what's something that you would, if you had someone you could pull aside and explain, you know, here's the mistakes I made and what would I do differently?

[00:57:12] And knowing what you can see now, what do you think, what do you think they need to know?

[00:57:15] Well, the first thing is find a mentor.

[00:57:17] You know, find a mentor that you like philosophically, right?

[00:57:22] Someone that as they grow, you can grow with it.

[00:57:23] As things change, you can kind of learn on their, their coattails.

[00:57:28] Second thing, and I stress this to every dentist, young dentist or old dentist is eliminate the undesirables in your practice, in your life.

[00:57:34] It's sad when I hear young dentists and, you know, I, I mentor about 50 young dentists a year.

[00:57:39] It's sad when I hear young dentists, that could be a 40 year old who can't wait till five o'clock on Monday.

[00:57:44] Can't wait till Friday afternoon.

[00:57:46] Can't wait to retire.

[00:57:47] And it's like, wait a minute, that's sad.

[00:57:49] You know, we should be, as you go back, like you said, Monday morning, you got some things that you learned this weekend.

[00:57:53] You should be fired up that your first patient opens her mouth.

[00:57:56] It's like, there's something I might be able to do that I couldn't do last week or last month or last year.

[00:58:01] Right.

[00:58:01] So eliminate the undesirables.

[00:58:03] And, you know, early for me is I never liked endo.

[00:58:06] And if I saw it on my schedule, it was like, this is a miserable day, you know, and it ruined my whole day, even though I was going to do some other fun things.

[00:58:13] Right.

[00:58:14] Right.

[00:58:14] And so, you know, to me, and it was like picking locks in the dark, you know, it's like click one more number and we're in.

[00:58:20] Right.

[00:58:20] And I thought that's not my deal.

[00:58:21] So no more endo.

[00:58:22] Of course.

[00:58:22] And the other thing that goes along with that is there are people who are freaking nuts about endo.

[00:58:26] They're endodontists and they live and breathe and that's all they want to do.

[00:58:29] Yeah.

[00:58:29] My wife is one.

[00:58:30] She loves endo and does a lot of it.

[00:58:31] She's a general dentist.

[00:58:32] I don't like removable.

[00:58:34] You know, my dentures never work.

[00:58:35] I, I, I'm worried about people.

[00:58:37] I'm worried about people like removable.

[00:58:39] I have some real concerns about people like removable, but your dad probably like, you know, he loves it.

[00:58:46] I know.

[00:58:47] Yeah.

[00:58:47] And so I eliminate that idea.

[00:58:48] I love kids, but I don't like doing dentistry on kids.

[00:58:50] And so what I slowly did is as my practice evolved and early on, because I realized I'm going to be in dentists for 40 years and 35 years.

[00:58:58] Right.

[00:58:59] That I had to eliminate those or it would be, it would be a burden.

[00:59:03] It'd be a slog.

[00:59:04] And, you know, I think these young dentists, they owe, they owe a fortune.

[00:59:07] So they're going to be in dentistry a long time.

[00:59:08] They can't, they probably feel like they can't say no to whatever comes to their, comes to them.

[00:59:12] And initially, you know, initially they're going to have to do that.

[00:59:15] You know, I did amalgams when I first got out.

[00:59:17] I did endo.

[00:59:17] I did not very well.

[00:59:19] I did removable.

[00:59:20] Yeah.

[00:59:20] And then slowly I, as I got busier, I could dismiss those things and really be good at things I like.

[00:59:25] So whether it's be placing implants or aesthetics or endo or whatever people like to do, you know, gravitate to those.

[00:59:31] Those are the kind of things you should be, you know, uber educated.

[00:59:35] Those are the kind of things you should be posting on Instagram.

[00:59:37] You know, the one thing we'd ever see on Instagram, we'd ever see beautiful removable from some of these dentists.

[00:59:41] You know, look at these dentures I did.

[00:59:43] You know, it's all this cosmetic, which is pretty, and that's a sexy part of dentistry.

[00:59:46] But, you know, there's other things to be marketed as a family or as a...

[00:59:50] Absolutely.

[00:59:51] As a family dentist.

[00:59:51] You know, no one's talking about, hey, look at all these great kids that came to my practice day and we had a great time and I brought a clown in.

[00:59:56] Yeah.

[00:59:57] It's like if I had a little kid, I'd want them to go to that dentist.

[00:59:59] Yeah, I want the clown dentist.

[01:00:01] Yeah, exactly.

[01:00:01] Yeah.

[01:00:02] So eliminate the undesirables.

[01:00:03] Find a mentor, eliminate the undesirables and do whatever you can to realize you're going to be a dentist for a long time.

[01:00:08] You know, this isn't, you know, a lot of dentists, they're trying to, you know, make all their money in real estate and stock market and Bitcoin, trying to get out of their perfection.

[01:00:17] It's like, I mean, yeah, that's fun.

[01:00:18] Make that a hobby.

[01:00:19] But your hobby should be dentistry.

[01:00:21] You should know more about dentistry than those things too, as far as being successful.

[01:00:24] I agree.

[01:00:24] And it is a practice and, you know, you've got to continue to grow.

[01:00:29] And like when I tell my kids, you know, my personal kids, I call them kids.

[01:00:34] They're 20s and 30s.

[01:00:35] Yeah, your mentors.

[01:00:35] Yes, they're kids.

[01:00:38] Is hurry up and slow down.

[01:00:40] Yeah.

[01:00:40] That's what I say.

[01:00:41] Because it's, I want to be you.

[01:00:42] I want to be a cosmetic dentist.

[01:00:43] I say, well, hurry up and slow down.

[01:00:44] You know, pick your path.

[01:00:46] Pick your path.

[01:00:47] But you don't have to run on that path.

[01:00:49] You know, but the important thing is to pick the right path so that, you know, as you make your decision, there's going to be wise and diversification.

[01:00:54] Versions, you know, along that way.

[01:00:56] But if you pick the path, and for me, it's non-compromising.

[01:00:58] It's just non-compromising dentistry.

[01:01:01] Trying to avoid mediocrity.

[01:01:03] You know, do something, do the things you can do that you can sleep at night and say, I made the right decision.

[01:01:08] I didn't screw my patient over and got a buck.

[01:01:10] Stay on that path.

[01:01:11] And, you know, dentistry is an amazing career.

[01:01:13] And, you know, there was someone this weekend that said, oh, I wouldn't choose it now.

[01:01:17] And it's like, I would.

[01:01:19] I mean, yeah, it's a lot of money.

[01:01:20] You know, when these kids come out and they have 400 grand.

[01:01:22] But it's been an amazing, rewarding career.

[01:01:25] And, you know, there's not many, I don't think, professions where you can change someone's life in a positive way and get paid for it.

[01:01:32] You know, really change their life.

[01:01:34] It's been good.

[01:01:35] That's really cool.

[01:01:36] So, for you guys that are listening right now, if you haven't joined the Facebook group, we have a very dental Facebook group is just sort of the podcast-centric group.

[01:01:45] I'm going to invite David into the group.

[01:01:46] I know you're not.

[01:01:47] Facebook is sort of a shit show.

[01:01:48] I understand.

[01:01:49] I do Facebook.

[01:01:49] If you're on it, you're already invited in.

[01:01:52] And we'd love to.

[01:01:53] If they have any questions or comments, it's a pretty good group.

[01:01:56] It's not a garbage fire like the whole group was.

[01:01:59] So, we'd love to have you there.

[01:02:01] So, if you haven't become a member yet, go find it on Facebook, the Very Dental Facebook group.

[01:02:05] Give us a password, Timmerman, or I'm going to do a new password, Timmerman or Hornbrook.

[01:02:10] You can get in.

[01:02:11] Now I'll remember.

[01:02:12] That's right.

[01:02:12] Now you remember it.

[01:02:13] And we'll get you in there.

[01:02:15] It's a good group.

[01:02:16] And if you haven't looked up, checked out the Voice of Dentistry meeting, which is coming up January 21st, 22nd in Scottsdale, Arizona.

[01:02:23] The early bird ticket is end of September.

[01:02:25] I think October 2nd it goes up or something like that.

[01:02:28] So, go get it.

[01:02:28] It's a cheap ticket.

[01:02:29] It's a cheap ticket.

[01:02:30] And it'll cost you more to fly there than we'll go to the meeting.

[01:02:33] We're going to have a bunch of good CE, good time.

[01:02:35] And I'm going to see if we can get some of these heavy hitters to come in and enjoy it.

[01:02:40] But thanks a ton for being on, Timmerman.

[01:02:41] I had a good time.

[01:02:42] Thanks for the invitation.

[01:02:43] I appreciate it.

[01:02:43] And thanks for coming to the veterans.

[01:02:44] It was fantastic.

[01:02:45] It was great.

[01:02:45] It was great.

[01:02:46] I've had so much fun.

[01:02:47] It's been good.

[01:02:48] It's been really fun.

[01:02:48] Thanks a ton.

[01:02:49] Okay.

[01:02:50] Thank you.