Very Dental Student: New Grad, Full Arch with Dr. Evan Pivetz

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[00:00:48] It's time for a Very Dental podcast just for students and new dentists. Welcome to The Very Dental Student Podcast. And now here's your host, Mohamed Aboubasha. Hello everybody and welcome to another episode of The Very Dental Student Podcast. I'm your host, Mohamed Aboubasha.

[00:01:05] Today I have a guest with me, Dr. Evan Pivitz. Dr. Evan Pivitz, he's one of the hosts on the Full Arch podcast. If any of you guys have heard of that or are interested in full arch implant cases, definitely go give that podcast a listen.

[00:01:23] So yeah, Evan, how are you doing today? I'm good. I'm excited to be on. Yeah, awesome. I'm excited to have you on. Yeah, Evan has a really kind of interesting background, which we'll get into. He graduated at The Ohio State University in 2021.

[00:01:42] And then talk to me about, first of all, why you went to dental school and then how you liked dental school and what you did when you first came out. Yeah, for sure. I kind of chose to go to dental school a little bit on a whim.

[00:01:56] I mean, there's no one in my family who's dental, medical, anything like that. I come from a family of mathematicians. So I just, I knew I wanted to do something in the medical field. I was pretty sure I was just going to be a doctor.

[00:02:11] And then one day my dentist was like, oh, come, come check it out, see what it is. And I did. And I was like, oh, it seems pretty chill. He's got a nice life. And I was like, sure, I'll do dentistry. I got nothing better to do.

[00:02:23] So got into dental school. I mean, dental school was hard. It was hard because on one side it was probably like the best time of my life. Met some of my closest friends, made lifetime friendships that I cherish the time that we

[00:02:41] were together and got to spend four years going through it. But at the same time, it kind of sucked. Didn't really have fun most days, but got through it. It was fine. So after I graduated, I graduated in 2021, which means that for my D3, D4 year, we were

[00:03:00] dealing with COVID. So it was rough. I didn't get a lot of requirements done. I mean, they lowered the requirements, so I passed fine, but I just didn't feel like I did enough.

[00:03:12] So my big goal coming out of school was to just find a place that I could do as much dentistry as possible and learn on my feet. So I looked around in Columbus, Ohio. Didn't find anything I loved. Just not great opportunities, big non-competes, that kind of stuff.

[00:03:30] So I decided to just pick a place on a map and move there and find a job. So I picked Colorado, looked around Denver, Fort Collins area, found a practice up near Fort Collins. And it was a nice heavy Medicaid practice.

[00:03:47] Really just getting a ton of new patients in, doing a ton of dentistry. So signed up there and started there right out of school. Yeah, I really like a few things in that story. Yeah, I also chose dentistry completely on a whim, just like you.

[00:04:03] It's almost exactly the same story. I mean, my family aren't mathematicians, but otherwise pretty much right on the same page there. And I wanted to unpack a little bit more, like how bad was the clinical experience affected by COVID?

[00:04:21] Because everybody, I've heard so many people talk about it at my school. But by the time I got into school, it was pretty much over, back to normal. So yeah, what exactly did you end up coming out with in terms of requirements?

[00:04:34] So I mean, pretty much they cut everything in half or a fourth because they made it so the clinic could only be every other chair. So half the chairs weren't in use. And then for every appointment, you had to have another student assist you.

[00:04:50] So for every chance you had to be in the clinic, half that time was assisting. So for all intents and purposes, they cut requirements by 75%. I think if I remember correctly, I think I came out with like 10 or 12 crowns, like three or four endos.

[00:05:09] I think I ended right around 75, 80 restorative, just not enough to feel comfortable, like enough that I knew what I was doing, but not enough where I came out. I was like, yeah, I'm ready to take on the world and just do whatever comes my way.

[00:05:23] So it was definitely a bit of a learning curve coming out of dental school, which I think even if you have hundreds and hundreds of restorations, it's still totally different coming out. But it was a lot of learning on my feet. Yeah, absolutely.

[00:05:36] Well, I mean, 10 crowns is still better than some schools require just in general. So at least you weren't like coming out with like two crowns. Yeah, yeah. I mean, it didn't feel like a lot. I mean, that's spread over two years almost.

[00:05:52] So you think about that, you're doing a crown once every couple months. It's not enough to get proficient. Yeah, that's a fair point for sure. Yeah. So then tell me about this job. You said it was a predominantly Medicaid office in the Fort Collins area.

[00:06:09] Yeah, just tell me a little bit more about your experience there. What your first of all, what the adjustment was like coming out of dental school to into that kind of practice and then what kind of things you were doing while you were there? Yeah.

[00:06:22] So I mean, it was a big adjustment. So the doc I worked for, thankfully, kind of knew what it was like for an associate coming in. So before I even started, like the week before I saw my first patient, he sent me to a molar

[00:06:34] endo course because he's like, you got to be proficient in your endo. So I came in and that very first week I did my first molar endo, you know, just packed my schedule right off the bat and it was crowns fillings, you know, running a column or two

[00:06:49] of new patients, checking hygiene and a column of restorative all on my own, just right off the bat. So a lot of that adjustment was learning how to be quick and efficient. Efficiency was like the biggest thing that I learned right off the bat.

[00:07:05] Like you can't waste time. You really have to learn to delegate to your assistants. And then also so like quick and efficient and then just being able to diagnose really quick on those new patients was the other big adjustment for me.

[00:07:20] So like the structure we ran, I had maybe 10, 15 minutes to go in, uh, look at x-rays in the room, talk to the patient about everything I saw, period chart and get out of that room as quick as possible while making good diagnosis and not coming off.

[00:07:37] Like I didn't know what I was talking about. So it was being able to like glance at a pano and some x-rays really quick, making a very quick diagnosis. And then going through the mouth and confirming all that. So it took some adjustment. I wasn't there right away.

[00:07:55] I kind of ramped up to it, but it was definitely a good learning experience and something that you kind of need to know. You need to be able to, you know, think on your feet.

[00:08:02] You're not going to be able to stare at a, you know, an FMX for 20 minutes before every patient and dissect every little thing. So it was good learning. Yeah. That's, uh, that's, uh, crazy to think about because I mean, I'm sure you're familiar in dental school.

[00:08:18] Uh, a new patient exam takes maybe like two, three hour appointments. So the, just the prospect of being able to do that in 15 minutes, um, I don't know something I can definitely look forward to so that I don't have to spend six hours. Yeah.

[00:08:36] And I mean, it's, it's a product of what kind of practice you're in. I mean, there's practices where they'll do a, you know, a two hour new patient exam and that doctor takes all the time in the world. And like, that's great. But we were a Medicaid practice.

[00:08:47] Like the people that were coming in had a ton of work that needed done. So if I caught 90% of it and then maybe at the next visit while I'm doing stuff, I catch something else and I let them know about it.

[00:08:58] Uh, it was the biggest thing was like getting the main areas of concern, getting them taken care of, getting their chief concern. You know, everyone has so much stuff going on. It was, you know, finding what's most important to that patient.

[00:09:13] What's hurting, what's bothering them, getting it taken care of and then down the line being like, okay, here we have some other stuff we got to work on. Um, and not getting bogged down on the small details.

[00:09:23] Um, you know, uh, a little occlusal that, you know, may or may not need to be done. You mentioned it to them, but it's not like your main point of concern when there's a big bombed out molar you got to take care of.

[00:09:37] Yeah, that makes a ton of sense. Um, you didn't mention you were doing, um, like the perio charting as well. So were you not working with hygienists? So we had so many new patients that if we tried to put them on the hygiene schedule,

[00:09:49] we had no room for hygiene. So we were doing doctor intake, um, new patients. I don't know if I recommend that for everyone. Ours was a necessity because we had a really hard time finding hygienists. So we only had two hygienists and they were booked out six months.

[00:10:04] Um, and we just couldn't afford to put, you know, 10 new patients on their schedule every day. So, um, you know, it's not the most ideal route, but it's what we had to do to keep seeing new patients. That makes sense.

[00:10:17] And, um, if I remember correctly, Colorado is a state that has FDU correct. Did you guys have something in the office? I had an FDU that ran with me at all times and an assistant as well.

[00:10:28] So you got really good at managing a schedule and quarterbacking a team and letting the F to know, Hey, like go into this room. And then in 15 minutes I'll be ready for you in the next room. And just, they follow one step behind you the entire day.

[00:10:43] Just, uh, I prep, they pop in Phil, I go back, just back, forth, back, forth. Yeah. That's awesome. Yeah. One thing, um, I feel like the diagnosis process and everything, um, for new graduates will,

[00:10:57] I feel like we'll be able to get up to speed faster, especially with, um, like the new, um, AI that will pretty much like outline the carries for you on a, what do you, did you ever get the chance to work with anything? I never used it.

[00:11:10] Um, I can't see it hurting though. Um, I feel like the main reason people are against it is kind of like a, I don't need something to tell me where the carries are, but if it was me and I had had it in that situation,

[00:11:23] I would have used it all day long. Um, that would have been perfect for my situation of if I had kind of like a prep of what I was looking for. And then I go in and I'm looking for those exact areas.

[00:11:34] It's no different than if you have a hygienist that's co-diagnosing for you and they come in and they're like, Hey, check these areas and you do, and you confirm it or deny it. Um, I don't see how it's any different.

[00:11:46] So, um, for anyone who's against that, I don't quite see why, um, I would have used that every day till Sunday. Yeah, definitely. Yeah. Well then, okay. So what were you doing in terms of your procedure mix?

[00:12:00] Um, were you like currently you're doing a lot of full arch cases. Uh, was that something that you were doing as well out of that office? Yeah. So I, I mean, I started just doing general dentistry, the whole gamut of general dentistry.

[00:12:13] I mean, it's distractions and, um, pretty much everything I could do, but about two month and a half, two months out of school. Um, I got a chance to go take an implant course at a local course in, um, Fort Collins where I was at.

[00:12:27] Um, and that was with Colorado surgical Institute. So, um, some great guys over there. I went there, uh, to learn some single implants. Um, they had a cancellation with, uh, one of their full arch docs.

[00:12:39] Um, so I ended up just doing a full arch the, at that course while I was there. Um, so that was my first introduction to full arch. Um, kind of fell in love with it right off the bat.

[00:12:48] So, uh, since then I've just been doing a ton of work on full arch. Um, I did my full first full arch in private practice probably like four months after that point.

[00:13:00] Um, and then while I was at that practice for the next two years, I think I hit around 25, 30 full arches there. Something in that range. Yeah. That's awesome. Well, um, I mean, that's actually crazy that you were going just to learn singles and then

[00:13:16] they're just like, Hey, you want to do it? It was a, it was a happy little accident. I was at the time I was like, Oh man, like that's, but you go to somewhere like impact implant pathway or something like that. You're still doing a full arch.

[00:13:27] Like you might not be immediately loading it and stuff, but they're on, they're not doing a lot of like single implants. So it was the same type thing. It's up. I got to scan it and immediately load it, which was pretty fun, but I don't know.

[00:13:41] I did it, uh, fell in love with it and kind of decided that that's what I was going to work towards just doing. Yeah. That's awesome. So now, now you're back in Columbus. Yes. Yeah.

[00:13:54] So I moved back in June of 23 and started a practice for a shared practices here. Um, and I'm just at a full arch, um, denture and implant practice. So it's kind of all I do nowadays is implants, uh, all enforced that kind of stuff. Yeah. Yeah.

[00:14:11] And for our listeners, um, shared practices, they're a podcast, um, and a consulting group, but they also have this, um, DSO that's opening up a denture and implant practices. And they're kind of an up and comer in the denture and implant space.

[00:14:25] Um, just for some, some background there. So talk to me about your transition from, you know, being pretty much, uh, you know, like a super GP doing all kinds of stuff and then going straight into just dentures and implants.

[00:14:42] And, um, I guess I'm curious, like, was it more exhausting at first or was it something that you felt like since you'd already done quite a few cases that you were, you were pretty much already ready for talk to me about? Yeah.

[00:14:54] So, uh, my impetus for switching was that I was doing, you know, all this GP work on the day to day. And that was most of my time I was not, you know, doing arches every day.

[00:15:05] It was, uh, you know, a few times a month I'd carve out a day where I was doing it, but the rest of the time I was doing general work.

[00:15:12] And when I was doing that, I just, I mean, I was spending all my time and my money and my CE time on implants and full arch and that kind of stuff. And then I would go back and then on Monday just do normal GP work.

[00:15:25] And I felt like I wasn't giving my patients, uh, my all just cause I wasn't spending time doing coursework on doing better crowns or doing better endo or all the stuff that it takes to be like a great GP.

[00:15:38] And like, I was doing good work, but I just knew that I wasn't going to take the time to go to, you know, like a spear or a course or learn more about, um, general dentistry stuff just cause my focus was on full art.

[00:15:50] So I was like, it kind of came point where I'm like, is it fair to them? Like, and I would just decided that for me, for my kind of the way my bandwidth works, it just worked better to focus on one thing and not have other distractions.

[00:16:03] So I switched to full arch. Um, I felt pretty comfortable with cases just cause I had done a good amount. Um, there's always learning though. I mean, I'll never be a hundred percent. Um, you know, there's always going to be challenges and that's what I like.

[00:16:18] Um, in all honesty, moving from like a busy GP practice to a full arch practice, I was kind of bored at first. Uh, cause a lot of your days you're just kind of sit, um, you're maybe seeing one or two consults in a day.

[00:16:32] Um, you're still not doing an arch every single day or anything like that. And on your off days, it's slow. There's not a ton to do. Um, so the way my days go now is I'll have like one or two days a week where I'm slow.

[00:16:46] I'm seeing a handful of consults, some post-ops, that kind of stuff. Uh, and then I have one day where I'm doing like a six hour all day surgery type thing. Um, so it's, it's a pretty big swing one way or another.

[00:16:58] Um, and that was a lot to get used to cause I was used to just being busy all the time. Did it feel like, did it feel like you were taking a risk leaving behind general dentistry

[00:17:08] and kind of like dedicating all of your time and all of your efforts towards just for a little bit? Uh, it was nice to have that floor of general dentistry. I mean, uh, just income wise, like knowing that I always had a steady base of general

[00:17:23] dentistry to, to fly me by and all the full arches were just gravy was nice. Um, so it was a little bit of a leap. Like if this doesn't take off, like if I don't do a full arch or enough full arches in this

[00:17:35] month, like I don't have anything else that backs me up. So there is a little bit of that, um, that you get into at the beginning. Um, but once you get rolling, uh, it hasn't been as much of a problem and, uh, you know,

[00:17:48] you start to finish up cases, um, you know, three, four months later, which helps in the month, but it is a risk. I mean, you're putting all your eggs in a single basket.

[00:17:59] Um, it was something that I've, I've, it was worth taking the risk for me, but it, uh, it definitely is a risk. Yeah. Yeah. And I'm sure, um, I'm sure it's less daunting having like a group that's been doing this

[00:18:14] and, and succeeding and starting up practices backing you up versus like if you were just to go on your own and try and do it, it would feel a lot more. I feel like it would feel a lot more risky. Yeah.

[00:18:27] It's definitely nice to have the backing of, you know, I have a central support staff that is taking care of a lot of the day-to-day stuff. Um, so I can focus mostly on my dentistry stuff, which is part of the reason I did, uh, jump

[00:18:40] into a group instead of doing it on my own is, you know, I was still at a point where I just wanted to focus on my surgical skills and get those, um, as good as I could get

[00:18:49] them and keep learning a lot of surgical stuff and taking a lot of CE. Um, and I just decided that doing that and also managing and running a practice, um, in a new town might be a little much.

[00:19:01] So joined with the group to have that, uh, that backing to help me out. Yeah. Um, so do you ever, I feel like you've already kind of answered this question, but do you ever miss doing just general dentistry or other procedures like endo or, um, or are

[00:19:17] you pretty much like fully in love with full arch and you don't, you don't really look at it. I still miss it some days. Yeah. There is an element to like quarterbacking a team that I really enjoyed.

[00:19:28] Um, I loved kind of having assistance and hygienist and telling people where to go and like managing a really tough schedule, um, and going through the day on roller skates. It made my days go quick and I liked that aspect of it.

[00:19:42] Um, I miss some of the predictability of the day to day of knowing that I can, you know, do a quadrant of fillings and knowing the exact time it takes. And you know, I didn't have to think about it too much.

[00:19:54] I could kind of turn my brain off and prep or prep quick crown, turn my brain off. Um, so there's things like that that I miss. Um, I mean, full arch is fun because every case is completely different. Um, and it's challenging.

[00:20:08] Um, but there is that aspect of, you know, bigger cases, bigger problems, bigger problems, more stress. So, um, I kind of traded like little stress doing GP stuff for, you know, it's great if

[00:20:23] a case is going great, but if there's things going wrong, it's, it's big stress, which is fine. It's what I signed up for and what I like to do. But, uh, sometimes I do miss the small stress of just general dentistry work. Yeah. Yeah, for sure.

[00:20:35] So talk to me a little bit more about, um, so you mentioned the CSI course, um, but what other types of courses or continuums have you done and which ones do you feel like, um, were the most instrumental in like, in like building your full arch?

[00:20:51] Um, yeah, just your confidence. Yeah. So, uh, that Colorado surgical Institute was the first one I did. Um, after that I did some online courses. Um, I know I did a couple of implant ninja courses. I did some other ones.

[00:21:04] Um, I think, I know I signed up for like a online lecture directory. I forget the name of it off the top of my head and watch like a ton of videos on there. And then after that, I went down to Mexico with the Worley implant Institute.

[00:21:19] Um, that was a great course. Um, I did their like advanced course, but I know they have a, uh, Burgina course that it looked like a lot of people learned a lot. Um, and then, uh, I'm trying to remember everything I've done.

[00:21:32] I did, I've done a, I did a full arch masters and full arch club mix course, which was great. Um, if people are looking to, you know, learn more on full arch and they're already kind

[00:21:43] of doing a little bit, um, full arch mat or full arch club is always what I suggest people go take. Um, it was very instrumental in my learning and I just, I think it shaped a lot of the way I still do full arch now.

[00:21:56] Um, I, I, after that I did a few more courses. Um, I just recently got back from Texas implant Institute, did a advanced, um, extra maxillary course there, which was pretty fun. Uh, learned a lot. Um, so yeah, I don't know.

[00:22:12] I, I'm big on just taking a whole bunch of different things. Um, just trying to go different places and hear different people talk. Um, so that's my big thing. I suggest people is like, you know, right out of the gate learning your first implants.

[00:22:27] I don't know if it matters so much what course you take, obviously go take a good one, but like whether you go to like pathways or CSI or really implant Institute, um, learning to place those first implants, you kind of learn the same thing.

[00:22:42] Um, it's once you get into practice and start doing them, eventually you get to the point where you start to see, um, kind of what is more advanced cases, like what can't you do? And from there, that's where the learning begins.

[00:22:54] Uh, I feel like, uh, the more that I learn, the more I see what I cannot do. And that's where I go and take my courses. So if I have something on my schedule that I'm like kind of stressed about doing, or

[00:23:06] I'm not looking forward to it, I'm like, I guess that's what I'm taking a course on next because I know that's, you know, the, what I need to brush up on. So there's, there's an infinite amount of things to keep learning. It never ends.

[00:23:18] So I just, I'm a big fan of, you know, I'll go back to places, but I like to learn from as many people as possible. Yeah. I remember I was listening to, uh, the full arch podcast and I don't remember who it was

[00:23:32] that said this, but it's like, once, once you get the basic all on X procedure down, it's really just like adding one piece of information at a time. And then you, that's how you become like a more advanced surgeon and be able to do the more complicated cases.

[00:23:46] So it's like kind of just going to these CEs and you just add one thing at a time. And now, and now you're doing remote Anchorage you mentioned, which is, um, a lot of people,

[00:23:56] a lot of general dentists or dental students can even imagine, um, getting to a point where they're doing, you know, any zygomatic or pterygoid implants. But, um, just really quickly, I wanted to touch on that.

[00:24:09] Um, do you ever get any, uh, you know, just bad vibes because you're a general dentist doing all these crazy implant cases or do you feel like, um, the surgeons you interact with are pretty, um, accepting of it?

[00:24:24] I mean, for the most part, I haven't, uh, had any problems. Uh, I probably am not interacting with the people that would give me problems too much. Um, but I know people who have, who have been, you know, no kind of looked down on by a surgeon

[00:24:38] or this or that. And for me, like my thing is as long as I, I know what I'm doing is correct and you know, I, I'm proud of my cases. My big thing is, you know, I want my cases to go somewhere.

[00:24:52] And if another dentist looks at them and it's like, that looks like good work, I'm, I'm happy with it. And if I don't feel like it's going to be that I'll fix it until it gets to that point.

[00:25:00] So I'm happy to stand behind my work and, uh, show off my cases. And at that point, I, if someone wants to criticize that I did it, um, they can, they can look at the evidence and point out why, uh, they think I'm not good enough to do

[00:25:14] it. So I don't know. Uh, obviously there's things that a surgeon can do that. I can't, um, they, their training is beyond what my training as a GP is. And I won't pretend like not, but I feel like I've done enough work myself to feel

[00:25:29] confident in doing my cases. Uh, and I'm happy to stand behind that. Yeah, for sure. I, uh, I really enjoyed one episode I listened to, um, where it was, it was, um, Soren and Tyler, they were talking to an oral surgeon. It's a recent episode.

[00:25:45] Um, they did like a series with him and he said that when he was first approached by a clear choice to start doing these full-arch cases, he was scared because he felt like he didn't, he didn't have the skills to be able to do that.

[00:25:59] And then he, he really didn't want to do it. So, uh, to me, that's proof that it's like, Oh, it's not really just like a surgeon's thing. It's really just the person who's done the training and gotten the reps.

[00:26:10] They're the ones that should be placing the implants and doing these cases. Yeah. I think that was the recent Matt Krieger episode that came out. And I mean, what I've found talking to people is that a lot of oral surgeons, and this isn't true for everyone.

[00:26:23] There's plenty that do, but a lot of them don't really learn a lot of, you know, all on four concepts in residency because they're doing stuff that's far and beyond that. Um, they're doing facial trauma and rounds of the hospital and stuff. And that's great.

[00:26:36] They can fix probably problems that, you know, I can't fix it and go above and beyond on complications and that kind of stuff. But, um, I feel like there's a lot of oral surgeons that end up having to go back and

[00:26:48] learn that all on four, uh, all on six concept, um, and like large fixed and figure that out as well. So, I mean, obviously everyone has their own opinion on that. Um, do I think every GP should just slam it all in for without training?

[00:27:05] No, but, um, I don't, I think there's plenty of room in this space for GPS to do beautiful all on four work. Yeah, for sure. Um, so when it comes to somebody who places a lot of implants like you, um, I've heard

[00:27:20] numbers and they're different numbers, but I've heard up to like 10% of implants fail. Um, if you're placing so many, like, are you seeing those same kind of numbers in your office or do you think that's, uh, maybe something that's like not necessarily accurate once

[00:27:36] you have the proper training? Like is every, are you feeling like every other case there's like at least one implant that's failing or not necessarily? I mean, um, everyone's going to get failures. If you're not getting failures, you're not placing enough implants.

[00:27:49] Um, you know, if you're placing one implant every, you know, couple months, yeah, you can say you might not get failures and you might be right, but, uh, I would be lying to say that I don't get failures in cases.

[00:28:00] Um, I try to keep those failures to a minimum and I try to plan my cases. So if there is failures, um, I have other things that I can do. Um, but yeah, I, I get failures. I, I'm pretty bad about tracking my percentages.

[00:28:14] I couldn't, I know some people can come on here and be like, yeah, I'm exactly a 96% success rate. I have this many failures per implants. I don't know. Um, ballparking though, I can say, you know, there's a handful of cases, um, from the six

[00:28:27] months that I've been open that have had failures. Majority of them have not. Um, and the one that have had failures, uh, you know, we've managed to take care of most of them. And there's some cases where, you know, someone's just going to get failure after failure after

[00:28:41] failure. Um, and those are the ones that, you know, uh, at some point I'm like, uh, it's like a systemic and you start looking at, um, different options for them. And that seems to be, you know, the, the one-off failures here and there is not too much of

[00:28:56] a problem. I don't see that that often. Um, when I do get failures more often, it's, it's someone that it's kind of repeated failures and you have to try to figure out, uh, why that might be happening. Yeah. Yeah. That makes a ton of sense.

[00:29:11] Um, so talk to me a little bit about this, um, this new course that you took. Have you, have you already been doing, um, extra maxillary implants beforehand? And is that just something you did just to further your training? Yeah.

[00:29:26] Um, I've been working recently on getting pterygoids into my practice. Um, that was kind of my, uh, 2024 goal. So I've started in January. I've been working on placing them and I've, I've placed a handful in my practice at this point.

[00:29:40] Um, the hard part is you can't really learn pterygoids without going to a course for Zygos cause they're always packaged together. Um, I'm not at a point where I'm going to place Zygos in my practice anytime soon.

[00:29:50] Uh, it's fun to go do them on a cadaver, but I'm, I'm not coming home Monday and putting some Zygos in, but to learn pterygoids, you got to go to a course and learn Zygos as well. So it was fun.

[00:30:01] Um, but the other reason I'm fine with that is I think I've said this before. I am, I'm happy and I like to, you know, always know a couple of levels above where I'm at.

[00:30:12] So, um, if I know the concepts of how to place a Zygo, what goes into it, um, if I see a case that I think might need Zygos, I can much better talk to that patient about their

[00:30:22] options, send them to a provider that can help take care of them and kind of know what they're going to be in for and give that other provider that I might be referring to kind of the best breakdown and workup that I can.

[00:30:33] So, um, even though I'm not placing them, I think it's important for me to know about Zygos because you know, I see someone here and there who probably needs one. And so, um, if I have no idea what I'm talking about, I can't really, uh, tell that patient

[00:30:50] where to go or who to see or that kind of stuff. So, um, yeah, I'm, I'm working on pterygoids now, but Zygos will be a little bit before I touch that. Yeah, that's awesome. I mean, just to think that you're already, you're already going into remote Anchorage

[00:31:06] and you only like what, seven months into your dentures and implants office. So I mean, you still have years and years and decades to do more complex surgery. I'm not in a rush to start doing them.

[00:31:22] Um, I've heard that once you start doing Zygos regularly, then you become the guy that does Zygos and everyone starts sending you them. Uh, and I don't know if I want to be the guy I like my, uh, relatively straightforward cases.

[00:31:35] Um, and I don't know if I want to be dealing with all the big complication cases on a day in day out basis, like some guys do. So, um, I don't know. I got my whole career to, to learn them and do them.

[00:31:47] But for right now I'm, I'm happy where I am and I'm happy not being the, uh, the Zygo guy in town. Yeah. Yeah. So, um, real quick, I just want to touch on sedation. Um, what kind of sedation do you typically run for these cases? Yeah.

[00:32:02] So I, um, am IV moderate, uh, qualified. So I do a lot of my own sedation. Um, I went through probably like a six month period where I was doing most of my sedation myself with a nurse kind of backing me up. Um, recently I've started using CRNAs.

[00:32:19] Um, Ohio's different than some States cause the CRNA can only do up to my level of sedation anyways. So I'm not really, you know, gaining, um, more sedative ability by using the CRNA, but

[00:32:32] it's just having someone who knows what they're doing and I can kind of turn my brain off from that point. Um, and not be looking at the monitor dealing about thinking about how much meds I need to give, keeping track of all that.

[00:32:43] So, um, that's typically what I do. Um, I kind of do both at this point now where some cases I'm just using a nurse and doing more myself and then other cases I'm using the CRNA just based on availability. So, uh, that's typically, uh, what I've been doing.

[00:33:00] Okay. Yeah. Awesome. Um, whenever you do have a CRNA come in, is the patient like paying, paying them separately or do you just bake it into your fee? So right now it's baked into our fee and I kind of like pay them off.

[00:33:14] I've been working on different ways to do it. It's a conundrum because if you, I've been thinking about having the patient just pay the CRNA directly at the time of surgery, but then it gets into, they need a check for,

[00:33:27] you know, that amount, which sometimes can be a lot. And I don't want that to be a barrier to entry if they can instead bundle it into like a treatment plan and finance that.

[00:33:36] So I, I'm constantly messing with my sedation and trying to figure out the best way to do it. Um, when I was in Colorado, I did sedations with CRNAs and they could do above my level of sedation. So they were doing deep sedation.

[00:33:49] Um, and I just bundled that into my fee and kind of ate the cost. But the hard part is they charge by, by the hour, by the minute. So it's different fee for every case.

[00:34:00] So you have to kind of guess what it's going to be based on your case times and hope that it's not over. Um, so it's all, it's all a game trying to figure it out. Yeah. Yeah.

[00:34:10] Um, well we've had a lot of good stuff there, but let's, so kind of to dedicate something to the listeners because we do have a lot of dental students. Um, like what would you recommend for a dental student who's interested in not necessarily

[00:34:26] maybe doing full arch, but maybe they are, maybe they are interested in doing full arch as well. Um, but what's kind of like the first steps, um, whenever they get out or to any new grads out there as well.

[00:34:36] Um, like should they be doing a lot of extractions first and maybe like get good at doing flaps, get good at suturing, get good at extracting and then go on to implants or what do you think is kind of the best way to go forward?

[00:34:53] Definitely extractions is like the best first thing to know how to do. Um, that's one thing being in the Medicaid practice. Like I got real good at doing extractions really efficiently and there's nothing that's going to slow a full arch case down.

[00:35:04] Then you know, someone taking an hour on extractions, uh, it's just, it, it can't be that long. It's gotta be quick. So knowing how to extract teeth efficiently, how to surgically extract teeth and being quick to switch to a surgical extraction is definitely a huge skill.

[00:35:20] Um, at that point you can start placing single implants. Um, you know, onesies, twosies, I think learning wisdom teeth, uh, and taking out wisdom teeth and knowing how to do flaps with that would be super useful.

[00:35:32] Um, it's not, that's not the way I did it just cause the doc I worked for was a excellent at wisdom teeth and had a whole thing set up where he was doing it one day a week.

[00:35:41] So I never really got good at taking them out cause I always gave it to the doc I was working for cause he was always, always looking for the cases. Um, but I think thinking back, if you got really good at taking out wisdom teeth, um,

[00:35:54] knowing how to drill those teeth out and knowing how to make that flap and being comfortable with that would be a good skill that would translate well into then doing like a full arch flap. Um, I don't know, I'd say go slow. I jumped into it.

[00:36:07] Um, and it was great for me, but I had, I mean, I had failures and problems because I went really quick and then had to backpedal and learn stuff. Um, whereas, you know, I think if someone takes their time and learns more on like a

[00:36:19] gradual step, you can avoid some of the pitfalls that maybe I ran into. So, um, my personality was I was going to jump into it no matter what. But if someone's thinking about it, maybe don't jump into full arch right off the bat

[00:36:32] and kind of wait in a little bit. Um, but personalities are different. There's going to be some people that just have to get into it right away. And if you do that, just, I, what I'd say is, you know, if you're going to get into

[00:36:44] full arch quickly, you just have to be able to manage your complications because, um, the worst scenario is you do something like that and then you have a complication that you don't know how to fix. Um, and that is when it becomes a sticky situation.

[00:36:56] Whereas, you know, having complications can be normal. Um, the big thing is knowing how to remedy it and make sure the patient still ends in a good place. Yeah. Okay. On, on that note, um, what is kind of the most common complication that you see when

[00:37:13] you're doing these surgeries? I mean, for me, uh, my big ones, you know, an implant failure I can deal with it's knowing where to place different ones, singles. Um, that's one thing I got is I got a rash of failures on singles and it was implants

[00:37:26] failing not integrating. Um, and at that point you have to learn how to bone graft really well, cause you're going to take that implant out and it's going to be a big crater and you have to know, Hey, I can graph this.

[00:37:37] I can come back in four months and it's going to be solid enough to place another implant. So, um, that's a big one. Um, getting good at suturing is big. I had some incision line problems, um, early on because my suturing was bad.

[00:37:50] Um, and you have to learn to, to suture well and make sure your case is closed effectively and there's not a lot of slack in those sutures. Um, so those are kind of the two big ones I see.

[00:38:01] I mean, there's other stuff that you run into, but you know, if you're starting on singles, um, the suturing, it shouldn't be as big of an issue just cause it's a lot smaller area, but it's still something you gotta look out for. Yeah, for sure.

[00:38:15] Yeah, I kind of wish, um, I got to do like more surgery in dental school. I haven't even started yet at all because I'm still a second year, but, um, like the general consensus is that everybody kind of wishes we would be able to do more.

[00:38:29] Um, but like they won't even, so like if, if it's an extraction that really shouldn't be surgical, like they won't let us like just go surgical just cause we want to, which to me doesn't make any sense cause it's like you're preserving the bone and like, why would

[00:38:45] you not? But they're like, no, you should be able to do it. So I wish I could implement some of the things I hear and actually kind of like get better at them during school.

[00:38:56] But it seems like I'll just have to keep watching videos and wait until afterwards to actually start implementing any of the, any of the little, uh, CE tips and tricks that I've heard and watched.

[00:39:08] I think for us, like we had to call a resident if we had to get a drill out and they had to like roll it out from another place. And like the resident had to come in and do it.

[00:39:17] Um, they were happy for us to sit there and kind of crank on a tooth for, you know, an hour and a half. Um, but you know, God forbid we tried to use a hand piece and they had to get the resident to come do it for us.

[00:39:28] So I don't know. Dental school is what it is. It's always going to be that way. So you just got to, I think it's all about finding a good place after dental school to learn that kind of stuff.

[00:39:41] Yeah, I'm definitely, uh, planning like one of my first things to get really good at, um, is going to be like extractions and grafting and suturing and then, um, probably single implants as well. I mean, I'm really, I'm really excited to get into this stuff.

[00:39:59] Unfortunately at Oklahoma, we, the undergrad dental students aren't allowed to place implants. So it'll be something that I'll definitely have to have to do right when I get out hopefully. Yeah, for sure. Yeah.

[00:40:10] I mean, my school made me not want to place implants with how like one, how boring they made it sound in the lectures that they talked about it. And then we weren't allowed to place either, but we had to go watch the Perio residents

[00:40:22] place implants, um, and watching two hours for like a single implant pay placement. Uh, and like, it was so boring. I'm like, I don't want to do this at all. This seems awful. Um, it took getting out into private practice and watching someone place an implant in like

[00:40:38] 10 minutes. I was like, Oh, okay. That can be fun. Yeah. Luckily, luckily I, before I started dental school, I was an oral surgery assistant and then I assisted a GP who was, I mean, pretty, pretty good surgically. So like I've gotten to see the cool surgeries.

[00:40:56] I've gotten to see what it can be like, um, with an efficient practice. So just going to have to like kind of work backwards and do things really unefficiently while I'm at the school and then go back and try and try and dig up those, those memories

[00:41:12] of how it was done whenever I was assisting. Yeah. So then really quick to wrap up. Um, is there any general advice that you want to give to any dental students out there? Um, and also, and this can be anything.

[00:41:29] Um, actually we can also talk a little bit more about the specific, uh, situation that you have with, um, uh, SPG in your office and how, how all of that works too. Yeah.

[00:41:43] So as far as advice for dental student, um, I wish I had done more stuff in school. Um, I was very narrow focused on school. Didn't look outside school. Um, I think if you're interested in this stuff or interested in owning a practice or anything

[00:41:59] like that, um, take the time to do some stuff in school. Um, it can be just like podcasts and stuff, but go to courses too. I mean, I know a lot of guys now who went and did implant courses and stuff in school

[00:42:12] and they gained a lot of valuable knowledge. Um, they went and did business courses in school and gained a lot of like idea on vision of what they were looking for outside of school. Um, and I was not that person.

[00:42:24] I had my head down and I was focused on school until probably my last year. I got really into podcasts and, um, started actually thinking about that kind of stuff. But at that point it was kind of too late.

[00:42:35] Um, so if you're thinking about it early, um, put the work in now, don't put it off for three, four years. Um, just because you're a student, because you can do the work in school and set yourself

[00:42:46] up nicely as opposed to kind of just waiting and seeing what happens. Um, and then as far as how my practice runs, uh, with shared practices group. So I'm all alone at a practice, um, here in Columbus. So, um, pretty much day to day.

[00:43:04] Uh, I manage my team in the office, but I have a company, um, that kind of helps out with, you know, a call center marketing, um, getting new patients in the door, um, and

[00:43:18] kind of helping train team a little bit, but you know, on the day to day, I, the, the, how the practice runs kind of comes down to me. Okay. Awesome. And then just for anybody out there, who's curious, is there, um, partnership opportunities

[00:43:37] or do you get any profit sharing, um, or anything like that? Yeah. So there's a partner, like an equity opportunity, depending on certain metrics that I might hit, um, over like a year span.

[00:43:49] Um, so it's all depending on like, if your office is doing well, um, at some point you can get a, uh, like percentage of that, um, off the top. So, um, haven't hit that yet.

[00:44:00] You gotta be there for like a full calendar year, but that's how it works. Okay. Awesome. Yeah. If anybody has any other questions or wants to learn more about this kind of stuff, um, you should definitely check out the full arch podcast.

[00:44:15] Um, there's way more information on there than you could possibly digest as a dental student. I still find myself listening a lot of times and pretending like I know what they're talking about. Um, but it is really, it's really informative.

[00:44:28] You can tell that, um, I mean, they're all, all of the hosts are really, uh, passionate about full arch surgery and they, they really do a lot. Like I know, like I think Tyler had done like an insane amount of CEU just right whenever

[00:44:45] he graduated dental school and Soren was already like, yeah. And Soren was like already converting cases or something for, for an oral surgeon or something before he, when he was a dental student.

[00:44:56] Tyler did so much CEU and then he went out of school and directly, um, started in one of their practices. Uh, but he was ready for it because he had done so much CEU and then Soren in school

[00:45:08] worked with an oral surgeon at like a hospital and did like a bunch of stuff with that. And then he was converting cases at Richard's office who is the original founder of SP.

[00:45:18] He would like dry and I think it was like over an hour on like days that he was supposed to be in clinic or something like that and go convert cases for him.

[00:45:26] So both examples of just doing stuff in school that sets you up for being out of school. And if I was a smarter and I could go back, I would make sure I put myself in those opportunities. Yeah, for sure. Yeah. So it's a wealth of knowledge.

[00:45:41] I'll definitely give that podcast a living, a listen if you're interested at all in full arch dentistry, even if you just want to know, you know, what's up, even if you don't foresee yourself going into that specifically, I'd still give it a listen for sure.

[00:45:54] Evan, it's been a pleasure having you on. Um, it's been, been a wealth of knowledge. I hope the listeners will get a lot from listening to this episode if they want to reach out to you. Um, is what would be the best way for them to do so?

[00:46:09] Yeah. Yeah. I appreciate you inviting me on. Um, I think probably the best way is just on Instagram. I think it's dr. Evan pivots. Um, I just DM me if you have any questions or anything like that. I'm pretty bad about actually posting on Instagram.

[00:46:22] Um, I tend to just forget about it, but I will answer. So that's probably the best way to reach out to me. Awesome. Yeah. Thanks so much for coming on and for the listeners. We'll see you in a couple of weeks.