Very Dental: The Art of Longevity with Dr. Marco Maiolino

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[00:01:45] [SPEAKER_01] what your practice could be saving. This is a production of the Very Dental Podcast Network.

[00:01:52] [SPEAKER_02] This is the Very Dental Podcast. Welcome to the Very Dental Podcast, where you'll find entertaining and relevant conversations with visionaries, clinicians, and your friends in the dental space. Now, here's your host, Dr. Alan Mead. Very Dental people, welcome to another episode of the Very

[00:02:20] [SPEAKER_02] Dental Podcast. I'm really glad to be bringing you another interview from the BioClear Summit 2026 in Scottsdale, Arizona. Now, what's interesting about this, this guest, he is a return guest from about 10 years ago or so that we were at a BioClear Summit here at the Scott Resort. So I met him in person the first time about 10 years ago. 2017. Okay, so it was like nine years ago. Okay, okay. This is Dr. Marco Maialino. Marco, how are you doing?

[00:02:48] [SPEAKER_00] Yeah, I'm doing very well. I still remember in 2017 when we did our first podcast, we were always in the same venue. We were here, exactly the same place.

[00:02:57] [SPEAKER_02] Yeah, it's, this meeting has been spectacular. Marco spoke yesterday. He spoke about a lot of really interesting things and we're going to talk about some of those. Marco, you're, you don't have an accent that people would think is Chicago or New York. You have an accent that's, that is a little different. Where in Italy are you from?

[00:03:19] [SPEAKER_00] Okay, yes, because I am anything but not from the US. I'm Italian and I live in Sicily. Okay. You know what is Sicily? Sicily is the small island in the center of the Mediterranean Sea.

[00:03:29] [SPEAKER_02] Yeah, yeah. Okay, so, and he came all the way from Sicily to Scottsdale to attend this meeting and I guess before we get into this stuff, I want to hear you and Dr. Clark wrote a book.

[00:03:42] [SPEAKER_00] Yeah. Is that right? It's coming out in the middle of November. Okay. Yes, it's something that's completely new. We have been presenting this book right here at the summit now. Okay. It is a 360-page book, 950 picks. Okay. And it's covering the bike rear method from the basic method for normal cases, class two, class one, the canalili, all these kind of things up to subgingival margins, quadrant dentistry, anterior restorations, bike rear veneers, full 360 degrees veneers, all these kind of things.

[00:04:11] [SPEAKER_00] Yes. We tried to cover all the, everything about what is about, about nuclear. Yeah. In this book. And the title was, give me the title. The title is interesting because you know, in the world that it is always contaminated by the idea of beauty. Yeah. On aesthetics, instead the book is the BioClear method, the art of longevity. Of longevity. Because this is, in my opinion, the real focus that we have to be in our everyday work. Mm-hmm.

[00:04:40] [SPEAKER_00] Yeah. Of course, and we want to present our best work. But in the real life, in my opinion, more than the absolute aesthetics, what works more is longevity. Yeah. Yeah. Because when you do a restoration, we'll know that maybe composite after a couple of years is not the same. Mm-hmm. But the patient is coming if the, the way, if this work is going to break, if he's going to experience

[00:05:06] [SPEAKER_00] complications. So, preservation and longevity of our work is the most important things. Yeah. Yeah. Because the threshold of our patients is completely different by our threshold. You know, the typical problems of the black triangle, no? Mm-hmm. Yeah. Now, being in BioClear, for example, we know that black triangle is important aesthetically speaking for the patients. But in the past, you remember, the perception of black triangles between the dentist and the patient was completely different. Yes. From the periodontist, for example, the rectangle was a good thing. Yeah.

[00:05:35] [SPEAKER_02] It was the opposite, for example. Yep. It's exactly right. I mean, like, in the 70s, they did all that periopros. Yeah. And that was, I mean, the, the case that was, the case that was ideal five years out had gigantic black triangles because it was health. They could get in and clean. Exactly. Yes. That's so funny. And now, now in dentistry, there's lots of people teaching ways. And unfortunately, some of them are really, really like, like, you know, veneers are really a lot

[00:06:01] [SPEAKER_02] of prep intensive. I honestly think BioClear is probably the, the far and away the best way to do it. And certainly the least invasive way to do it. Of course. Yeah. And that's kind of, it's kind of the, this weekend I've heard a lot where I'm doubling down on the idea that this is, this is the way of doing things with BioClear is literally the, the least invasive way to do

[00:06:20] [SPEAKER_00] things. It's the least invasive way. And what you know is the approach with whom you treat the majority of patients. Because for most of the patients, of course, if you compare BioClear veneers to ceramic veneers made by a very good technician, there is a difference. But in the real world, for most of the patients, this difference is much more in the eyes of the dentist. Yeah, it is. Of course, you have to be very smart because this happens to understand who is the 10%,

[00:06:47] [SPEAKER_00] 50% of patients that want ceramic veneers. Yeah. Because it happened to me to deliver BioClear veneers to these kinds of patients and they are not happy at all. So there are patients that want really that kind of result. Yeah, yeah. They are 10%. Yeah. Yeah. You have to be smart to recognize the 90% with whom you can work in that way. It's really good point. And the 10% where you have to work instead in a cosmetic way. Because, okay, in these two days, for example, I've been listening too many times the word cosmetic. But we have to be in the

[00:07:16] [SPEAKER_00] same way John Kademi, you know, he's obsessed about the lexicon, about endodontics, about findings, lesions. The same is cosmetic is cosmetic dentistry. But what do you are? You are a cosmetic dentist or you are a healthcare provider? Yeah. Because if you are an healthcare provider, honestly, when you do your dentistry, your main aim is to preserve the dental structure. Yeah. Your main aim as a healthcare provider is the longevity of the dentition. The side effect has

[00:07:45] [SPEAKER_00] to be an aesthetic work. So anyway, in our work, we have always to understand that there are different priorities. A perfect work doesn't exist at all. Yeah. Because what is perfection? Perfection is that you have everything on every side. But there is nothing something like this. Because when you want to be, if I want to be 100% cosmetic, I have to prepare more. Yeah. There's no way. Yeah. So okay, cosmetically speaking, maybe the work is perfect. But from a

[00:08:13] [SPEAKER_00] biological point of view, the case is a mess. Yes. So there is always a price that you have to pay. If you want to be minimally invasive, it's the opposite. Aesthetically speaking, you are compromising something. So it's much more about a matter of priorities. What is your priority in dentist? I'm not a cosmetic dentist. I don't advertise myself with patients as a cosmetic dentist. Yeah. What I do with

[00:08:38] [SPEAKER_00] my patients, I advertise myself as a longevity dentist. And this is the reason because the idea of the book, of the subtitle is mine. But the art of longevity is because it mirrors what I really think is much more important in dentistry. Because if I have to say after 25 years of work, the most important parameter in my practice that is connected to patients' happiness, we can say,

[00:09:03] [SPEAKER_00] outcome and well live life for a dentist is the longevity of what we do. Yeah. Longevity is the

[00:09:11] [SPEAKER_02] most important part. Yeah. Yeah. I mean, and that gets into a lot of stuff. I think that, okay, so first thing that comes to mind, dentistry, everyone knows from in the United States, everyone knows, you know, from your first year out in private practice that your crown has to last at least five years for the insurance to cover it again. I mean, like, it's literally the exact

[00:09:38] [SPEAKER_02] opposite of what you just said. Like, if you're concerned with longevity or you could be concerned with, well, it'll make it five years. I mean, which is so gross, obviously. Yeah. You are

[00:09:47] [SPEAKER_00] concerned with the insurance. Yeah, exactly. Exactly. This is, okay. Again, it's a matter of priority. Your priority is comedic dentistry. Your priority is like me, longevity dentistry. Your priority is to save teeth. Your priority is the insurance. Yeah. This is another kind of fantasy. Like yesterday, when we had the discussion about informed consent. Yeah. You were in the, in the, in the, yeah. Yeah. I love it. I asked about definitions and there were, for some people,

[00:10:12] [SPEAKER_00] informed consent is just a way to defend ourselves against any problems with the patient. So, the definition of informed consent was just to defend myself from the patient. Yeah. From

[00:10:23] [SPEAKER_02] a legal problem. Yeah. Yeah. So, a lot of people are like, informed consent is about making the

[00:10:27] [SPEAKER_00] lawyers not come after me. Exactly. The way in which we define things, the way in which we define problems, define our practice and define our mindset also. Like, for example, yesterday, we were discussing about informed consent. What is informed consent again? Because the way in which deliver information, informed consent is what we want. Yeah. The way in which we deliver information is pushing the patient in a direction. Yeah. It is. It absolutely is. Absolutely. And people,

[00:10:54] [SPEAKER_02] people want to believe that I have this conversation all the time. Well, as long as you've given them all of their options, including no treatment, then you're covered. And you're like, the reality is, is every dentist knows that if I were in this situation, what would I want? Yeah. What would I want from being delivered by me? Because I know where my strengths are. I know what I do best. I know what in this sort of thing. So, the reality is, informed consent is not this like, you know,

[00:11:23] [SPEAKER_02] checkbox thing. It's literally, tell me more about that. Tell me more about it. It has a lot to do with what the dentist thinks and what the dentist wants. And it's everything that relates to the

[00:11:32] [SPEAKER_00] dentist mindset. Because, you know, people is full of, and dentists also, are full of psychological biases. Yes. Yes. So, for example, if I explain something talking about success, I give a message. Yeah. If I talk with the same patient talking about the risk of failure. Yeah. Or complications. Yeah. I'm giving the message in a completely different way. Yeah. Yeah. Doing this, I can drive the discussions wherever I want. Yeah. For example, also regarding complications. If I give you a

[00:12:01] [SPEAKER_00] warranty, like I do, for example, in my office. Mm-hmm. I'm moving the risk of the problem on myself. Yeah. Instead, if I'm working with the patient saying, okay, we can do this, but if it fails, you have to do again the work. Yeah. I'm doing exactly the opposite. Yeah. So, everything that I say is moving the discussion and the decision of the treatment plants in a direction. Mm-hmm. And to think that informed consent is something that really, something that really exists,

[00:12:31] [SPEAKER_00] is a myth. Yeah. It doesn't exist. Because each kind of discussion will be driving in a direction. Yeah. And everything is about the mindset of the dentist. Yeah. Too many times we do also mistakes as dentists. And I believe, and I know this because I did this myself several times in the past. We decide at the place of the patient. Mm-hmm. Sometimes we think, oh, this treatment is complicated. This treatment is expensive. This patient is not going to accept. Mm-hmm. And we

[00:13:01] [SPEAKER_00] never say to the patient, okay, you can do this. Mm-hmm. This is something that we do too many times in my practice. Mm-hmm. For example, in my area, no? I treat a lot of patients with pre-dental problems, no? Mm-hmm. And the patient with more dentitions. But the real problem is that few patients know that they have pockets. Yeah. Few patients know that they have, for example, a more dentition that you can treat maybe with veneers. Yeah. Direct or indirect and with overlays in a very minimal way. Yeah. Because the problem with this, especially in Mary Ida, doing a work like

[00:13:30] [SPEAKER_00] this is 20, 25,000 euros. That's right. And the dentist is always with a mindset, especially in Sicily, because in this moment, Sicily is everything but not a wealthy person. Right, right. A wealthy country. Yeah. They think, oh, this patient is not going to spend 20,000 euros. So why lose my time proposing like this? Yeah. So you have patients going everywhere with this kind of dentition, mm-hmm, without never realizing a solution to their problem. Yeah. Until they lose all the

[00:13:58] [SPEAKER_00] order. Yeah, yeah. And at the point, instead, it's very easy because the problem now at this point is magnified to say, okay, we extract everything and let's place four implants and do all long four. Yeah, yeah. What is happening in dentistry is that we are always starting to live in the extreme. Doing as small as possible on this kind of complex cases till they arrive at the end. Exactly. And after is the easy solution. Yeah. Now we have to extract everything just for implants and

[00:14:24] [SPEAKER_00] then we do all long four. Yeah. And this is what is happening. It's interesting because I think,

[00:14:33] [SPEAKER_02] I don't, I can say this, University of Minnesota didn't teach us very much about worn dentitions. In fact, I came out and it's taken, it took me a lot of years in practice before I even was really recognizing and understanding is the problem that is. And frankly, that the solution is that there is a solution. In a lot of cases, it's like, well, that's, they've worn their teeth. What are you going to do? You know, it's like, and, and that's an interesting, it's an interesting thing.

[00:14:58] [SPEAKER_02] And then of course, when you look at what you're going to do, it all of a sudden becomes a really big case necessarily, or depending on who you're listening to. And what's funny is, I mean, BioClear among other places have, have offered some different kinds. It's, it's expensive because it's kind of, you can't really treat one tooth in a lot of cases with these. There's a lot of teeth that need treatment. Yes. But that, that, that in and of itself is, it makes sense if you're wearing a dentition,

[00:15:23] [SPEAKER_02] you need to treat a dentition. Yes. And, and I'm okay with that. So, but as you said, it's kind of hard to explain that to the patient. Yes. Because the patient is coming because I broke

[00:15:35] [SPEAKER_00] my anterior incisors. Exactly. And to explain that, because they are the two broken teeth, the incisors usually, they have to rebuild the whole mouth. Really? I just want these two teeth fixed. Exactly. I know that's demanding. I know that's demanding. It's also funny because in, in many cases, but again, it's the problem of before because this is a hard, this is embarrassing. It is. And so the dentist is going, is not going to propose that to them to the patient. No, you're right. You're right. Because the patient is thinking,

[00:16:02] [SPEAKER_00] how do I can explain to these people that he's coming for two and they have to propose, let's say 12. Yeah. But again, this is a problem of the, of the dentist. Yes. Because despite the problem of the dentist, the problem of the patient is not changing. Yeah. It's not because you are not proposing the full monitor. No, that's exactly. That's a great point. That the problem is solving. Yeah. So you're just leaving a person with a problem without a solution.

[00:16:23] [SPEAKER_02] And you're really not even identifying the problem for them. They're kind of, you know, it's in, and I mean, I'm guilty of this too. It's, it's a, it's a great point. And I will say that one thing about informed consent, I talk about this a lot is I, I think a lot of times people think with the right amount of education, with me explaining things exactly right, that the patient will all of a sudden understand exactly what's going on and be able to make the right choice. And I think to myself,

[00:16:51] [SPEAKER_02] dentists know a lot more about these conditions than patients do. We're not really in a position to be able to explain if for actual informed consent, how much would you really be able to explain? I mean, it's like, you'd have to give them your entire dental education.

[00:17:05] [SPEAKER_00] You know, there's a similar discussion in the financial world with the so-called homo economic. Yeah. Yeah. In the past, they were thinking that the economic world was rational, no? So it was everything, it was about the rational choices. Yeah. Yeah. Yeah. And according to this, everything was a mess because the humans do anything but not being rational. Exactly.

[00:17:26] [SPEAKER_02] Exactly. Exactly. We are just emotional beings. We make, the assumption was always that we would make the, the, the rational choice. And, and the classic thing is when you look at it in reality, it's like, we never do. We never do.

[00:17:38] [SPEAKER_00] It doesn't exist. Yeah. We have to acknowledge that we are emotional beings. Our patients are like that. So the problem is just one, that the idea that we deliver information so that the patient is able to decide is wrong. We have to accept that the patients are not able to decide. So what we have to do is let's interview the patient, understand what the patient wants, what is the goal of the

[00:18:03] [SPEAKER_00] patient. And after we have to take the responsibility to give them one single solution. Because when we give three different solutions, it is very typical in Italy. Because in Italy, what, what, what most of the entities are doing. Okay. The treatment plan, the best is expensive. So I can propose this, but because I'm scared that the patient is getting scared and not going to accept, I also give the B, the intermediate one.

[00:18:28] [SPEAKER_00] And just in order not to lose the patient, I'm giving also the C, the cheap one. Yeah. So you're leaving the patient with the A, B and C. And what is doing the patient? You know what happens? Statistically speaking, the patient is deciding only according to his mindset. Yeah. There are patients that always want the best. And they are going for the A. Yeah. The patient that doesn't understand anything, so he's doing or the cheap one, or he's going somewhere else. Yeah. He's going somewhere else because he wants somebody. Because another problem that we have is about

[00:18:57] [SPEAKER_00] education. The patient is not coming in the office for being educated. Yeah. The patient is coming in the office to remove his doubts. Yeah. Because I had a problem with my meniscus, with both meniscus. Yeah. When I had problems with my meniscus and I was going for different surgeries, okay, they were showing me my MRI on these kind of things. But at the end, what I want to do, I have to do this fucking surgery. Yeah.

[00:19:21] [SPEAKER_00] Or not. Yeah. Yeah. This is what I wanted to say. I wanted one person just saying to me one single answer. Yeah.

[00:19:29] [SPEAKER_02] So, I mean, like literally, when you said that yesterday, when you said, we need to... The patient is coming to you not for anything other than they want to remove the doubts. Yeah. Yeah. And I'm like, oh my God, that's exactly right. It's exactly right. And you know, that we should feel really good that they've chosen us to come help them with that. Yeah. Like that's a big deal. I mean, it's like you said, it's not just informed consent. We're having communication. It's a responsibility that you're taking. And that's a big deal. You have to understand

[00:19:55] [SPEAKER_00] the patient. This is a psychological work that at dental school nobody talks about. Yeah. Yeah. Yeah. So, there is a work that we have to do and it is to learn to interview a patient. Yeah. Yeah. Psychologically speaking. Yeah. Because we have not to propose what we do on ourselves. Yeah. We have to do what is best for the patient. Yeah. So, is the patient interested in cosmetic at which level of prosthetic? Yeah. Yeah. Top level cosmetic, average cosmetic, reasonable cosmetic at the point. Is this patient

[00:20:22] [SPEAKER_00] interested in what? Yeah. Teeth preservation, cheap therapy, is able to spend money, is able to stay on the chair for a prolonged amount of time. Yeah. Yeah. All these kinds of things. Yeah. After we do all this kind of interview, you come on the table and you said, okay, I think that I understand what you want. And for me, your solution is this one. Is this? Is this one. For example, there are patients. I have old patients where I work with composite. And when I talk about, okay,

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[00:21:26] [SPEAKER_00] I show some photos and the patient is saying, oh, it's 10 times better than my teeth. If this is coming in this way, for me, it's perfectly fine. So with this kind of patients, when the aesthetic request is in that way, you have freedom and you have room for doing one treatment plan. But the opposite is true. So you have to really understand patients. And what I have to say, I'm getting always better and better after 25 years of work, is understanding exactly what the patient is asking for.

[00:21:55] [SPEAKER_02] I want to hear, okay, so what's your process? Because, because, you know, I've gotten it wrong before, where I thought I really understood the patient and I've got it like, so how does, how does Marco try and get the best understanding of what the patient wants and needs? Okay. You know,

[00:22:12] [SPEAKER_00] the main point is, it seems obvious, but it is let them talk. Yes. Let them talk. Because for example, when you have a patient with one dentition, I ask the patient, do you realize that you have one dentition? If the patient is saying yes or no, the discussion is already moving in direction, another one, for example. Yeah. Because if the patient, for example, he says, I have one dentition,

[00:22:36] [SPEAKER_00] I never realized that I have one dentition. I show some photos of what is a normal dentition. The patient is not interested, why I have to push? If the patient is not interested in something, it's impossible to push them. Maybe I will propose something like a bite, a protection, just in order to present this teeth more over the time. Yeah, yeah, yeah. And I can stop it there. Yeah. It's useless to go beyond this. Yeah. But after, for example, you start discussing about this and the patient is interested and you show

[00:23:03] [SPEAKER_00] some photos, you do, for example, I use Smile Cloud. I do a Smile Cloud most of the times at the first appointment and I show the patient what we can do. Yeah. If the patient is interested, we go deeper in the discussion. Yeah. And we start to analyze, for example, ceramic or composite. Which kind of aesthetic do you want? We start to go in that direction. Yeah. Also, there are several things about one dentition also about the problem of the function, for example. Now, I started

[00:23:31] [SPEAKER_00] to apply in my practice as NEP1 appliance made in PMMA to this function without any kind of preparation. Because another thing is, of course, it's difficult, especially in my area, to propose and to make the patient accept immediately 25,000 work. Yeah. So what I do, I do a sort of ladder. Yeah. The first ladder is my cloud and it is included in the first consultation. Okay. The second ladder is just the aesthetic mock-up. Yeah. That they do just with flowable material. Mm-hmm. Because the patient

[00:23:59] [SPEAKER_00] has to live for half an hour, for one hour, the final Smile. Yeah. At this point, and the patient is paying just this small step. Yeah. Yeah. The other step is these appliances that they call the rebalances. Yeah. Rebalances. These are PMMA milled provisional, so snap-on. Yeah. With zero preparation. Okay. Because most of the time, you know, with this kind of approach, I can work with 0.2, 0.3 millimeters and I always increase the vertical dimension. Yeah. So I can do

[00:24:26] [SPEAKER_00] without any kind of preparation. Yeah. And with this, the patient is able to eat. Yeah. To chew. Yeah, they are. To talk. So you test the phonetics. Yeah. You can cement with the temple clear. Sure. Sure. This kind of appliances. Sure. The patient is able to chew. And you've not

[00:24:39] [SPEAKER_02] prepped the teeth. Yeah. You've not prepped the teeth. Yes. You've essentially given them

[00:24:42] [SPEAKER_00] what you're proposing. Yes. They're living with it. And at this step, the patient that they rebalances, is going to spend something like 1,000 euros. Yeah. And they have the chance to go back. Yeah. So I do something in order that the patient is also going into this kind of direction in a gradual way. Yeah. Because he has to be able to say, I don't want this kind of result and to go back. Yeah. Yeah. Because the last thing that they want, and this happened to me in the past, is you know what?

[00:25:07] [SPEAKER_00] You do a wonderful job. Like you place veneers, you finish and the patient is saying, these teeth are long. I don't like them. And you say, fuck. Yeah. Because this happened. Yeah.

[00:25:18] [SPEAKER_02] Of course. Of course. Yeah. Exactly. Well, I mean, I love that approach. The approach is technically for at least a little while, completely reversible. Yeah. At the beginning, yes. Especially when you're opening their bite. I mean, man, when I was in dental school, if you talked about opening their bite, it was like you were taking your life in your hands and most people can't tolerate it. And of course, realistically, when you open someone's bite, they actually usually tolerate it really well. And you know, the reality is sometimes it actually helps with pair of functional

[00:25:43] [SPEAKER_00] problems, that sort of thing. But you know that during the life we lose vertical dimension. Yeah, of course we do. So why don't revert? Yeah. In this world, we are always talking about anti-edging, but not just anti-edging, aesthetically speaking, but anti-edging also from a functional point of view. Because if you see when you lose vertical dimension, the length of the length of the muscles is getting shorter. Yeah, it is. Yeah. There is much more activation. Yeah, it is. Much more parafunctional. Yes. When you increase the vertical dimension, there is a wonderful thing we never talk about.

[00:26:10] [SPEAKER_00] If you see the neck of people increasing vertical dimension, you see that there is a contraction of the neck is completely different. Yeah. Because we are connected by, I don't know the name in English, it's fascia in Italian. Yeah, yeah, yeah. Yeah, yeah, yeah. We have just one fascia connecting the muscles of the mouth with the muscles of the neck and the shoulder. Yeah, it's the connective stuff. Exactly. Because it's the vertical dimension, the activity of the muscle is connected with the other muscles, and everything changes completely. Yeah.

[00:26:39] [SPEAKER_00] And you see that the contraction of the muscles of the neck is changing completely. If I show you photos about this of patients of mine, all the patients improve a lot about this kind of area of the neck. Yeah. It's incredible.

[00:26:51] [SPEAKER_02] Well, and you're basically talking about giving them a milled, reversible version of what you're proposing. Yes. And the reality is you're opening their bite at that point. Always. And they're testing that out. Always. They're making sure, and you're finding most times that people not only tolerate it, but probably do better as far as less parafunctional, less muscle pain, that sort of thing. Almost always. I love that. I love that. And by that time, it really gives the patient a chance to buy in and decide that this is the right thing for them. Yes. But you've delivered this in a way that I would argue is probably better informed consent than,

[00:27:19] [SPEAKER_02] you know, like they're living it, they're understanding it. Yeah.

[00:27:22] [SPEAKER_00] And also you're moving because when you do the first consultation at the end, you're just talking and the patient is not able to understand them for a while. Yeah. Yeah. Five minutes, he's gone. Yeah. When I explain the periodontal disease, do you think that I can explain the bone? I'm just saying you have a disease that will bring you to loose teeth. Yeah. They will become longer. They will come out like a witch and after they will fall on the floor. That's right. This is all my explanation about the periodontal disease.

[00:27:50] [SPEAKER_02] It's probably better than any. Yeah. Because the crazy thing about perio, of course, it doesn't hurt. For them, usually it doesn't hurt at all. So people, you know, like, like you, you really have to spell it out for them. Yeah. Because, you know, so much of it doesn't hurt at all. That's, that's, I really like that. So, so then once they've done their, their, they've worn their mill, uh, trial period or whatever, and then they've decided this is what they're going to do. And then you can move into preparation or, or whatever modality you're going to use to.

[00:28:16] [SPEAKER_00] Also today we have wonderful differences because we can walk also with dialogue. I work a lot with the transparent, uh, indexes like ExaClear. Yeah. And do flow injection. Yeah. Yeah. Yeah. And do some technique. Yeah. And you are able to do increase of vertical dimension, even of like something like one millimeter. Yeah. In the anterior at 0.5 in the posterior working just with composite. Yeah. Because this new composite that we have on enamel are able to be quite stable over the time. Yeah. And you can do also these kinds of things. Yeah.

[00:28:43] [SPEAKER_00] Yeah. Because the aim is always to be as much biological as possible. Yeah. And to preserve as much tooth structure as possible.

[00:28:49] [SPEAKER_02] And when you think about it, tooth wear means a really good treatment for tooth wear is additive, straight up additive, as much as you possibly can. Always. Because if you don't have to, if you can avoid prepping anymore. Yes. You know, because they've been essentially prepping their teeth their whole life to get to that point. So I love that. And that's, I mean, it's kind of BioClear talks all about that. But what's interesting too is, I mean, the injection, um, Dave's not the only guy that's been thinking about injection molding over these years. You got the, you got the different, um, like you said, the clear matrices. Yes.

[00:29:19] [SPEAKER_02] And I know that, I think I saw your name. Isn't that, is the injection molding comp, uh, the, don't you do one in Europe? Like a, like a, I'm curious about that.

[00:29:28] [SPEAKER_00] Yeah. Last year I've been the organizer of the injection summit. Injection summit. That's what it is. Injection summit. It was November, 2025 in Milan. Yeah. There were, uh, 130 persons. Yeah. They came. It was in Milan and it was about the summit about all the injectable techniques. Yeah. There were, there was BioClear techniques. Yeah. The flow injection technique, the one with the holes in the, in the XA clear. Yeah. The stamp technique, because there are, there are several small nuances between the stamp technique. Yeah. There was also in here,

[00:29:57] [SPEAKER_00] the technique with, uh, you know, I've been here. Yeah, I guess. Yeah, yeah, yeah. Yeah, yeah. With the heat initial. Yeah, yeah, yeah. Like a dear friend of mine. Yeah. We did a summit where all the techniques were on the stage. Yeah. And I'm doing the same next year. Oh my gosh. In Bologna. Oh, nice. It will be in May. Okay. And, uh, you know, it's exactly in the historical center of Bologna. and we have been hiring a baroque church. So it will be in the church. Oh, I love that.

[00:30:24] [SPEAKER_00] Because the idea is that I have to be the priest of the injectable technique. I like this. I like this a lot. It will be amazing.

[00:30:30] [SPEAKER_02] That's really cool. I'm going to get some information on it.

[00:30:32] [SPEAKER_00] Also because it will not be just an educational event. This is a church. The venue is fantastic. And we have been hiring a super special service about lights, music. So it will be something in the middle between education, entertainment, and the show. Oh, I like that. This is the reason because the name of the Congress is The Injection Show 2027. Oh, that's really cool. Okay.

[00:30:54] [SPEAKER_02] So we'll get some information on that. We'll put it in the show notes too. That's fantastic. So the one thing that, I mean, the informed consent conversation really moved me yesterday. But the other thing that really moved me was, okay, so like you showed a slide, and we can kind of go back from here, but you showed a slide of a patient who had an all-on four or basically… All-on six. It was an all-on six. Entire. And what was really funny was in the context of who you were speaking to,

[00:31:22] [SPEAKER_02] it was someone who had a failing dentition. It was essentially like you were talking about where, you know, it wasn't addressed, it wasn't addressed. And then, you know, this person chose to do this, which is a pretty radical treatment. Yeah. When they had teeth that were restorable, they had other options. And what I laughed about was like at a certain meeting, maybe a meeting that's teaching a lot on, you know, implant-based, all-on four, all-on X, whatever, that would have been an absolute triumph of a case.

[00:31:51] [SPEAKER_02] I mean, big, beautiful white teeth. She had a big white smile. It was great. But, like, everyone there, everyone in our meeting just went, oh. Yeah. In disappointment because the pre-op was like, I thought it was a case you were going to show that you had done and restored her teeth.

[00:32:06] [SPEAKER_00] And so it was like, it was sort of a… And try to think. I always used to think. Which kind of informed consent was in that case? I explained because I have been listening to this too many times. Yeah. Ah, you have periodontal problems. You need several surgeries. Yeah. You need after two years at least of orthodontic treatment. And after maybe we have to do crowns everywhere. So it's a super expensive and super long treatment. Instead, we've done session.

[00:32:35] [SPEAKER_00] We remove the teeth. Yeah. We place six implants. Teeth in a day. And we will do in one day, we will do everything. This is the informed consent. Yep. So again, in that case, they have been driving the patient in the direction they will.

[00:32:46] [SPEAKER_04] Yeah. Yeah. And what?

[00:32:48] [SPEAKER_02] I'm not a big fan, but there's a lot of that going on out there. Yes. And what's interesting, this is the other conversation I wanted to have with you. Like, I know in the United States, you get a lot of these younger dentists coming out. They have a ton of debt, a ton of debt to have gone to dental school. They're looking at maybe owning a practice or finding a place where they can start getting… And it's really easy to see that these are profitable and quick turnaround procedures. And patients will get financed for them. And it's big money and quick.

[00:33:17] [SPEAKER_02] And this is a great way to… And I mean, the financial motivation is you can't miss it. You know, it's there. You can't miss it on that level. But it's, you know, I don't know how much talk there is about how… This is probably not great for the patient in a lot of cases.

[00:33:34] [SPEAKER_00] The problem that you know is that we are coming from a culture where the economical prices that we have in dentistry are wrong. This is the point. Yeah. Because I don't know exactly the point. In Italy, in the past, I understand. Because the level of restorative and endodontic work was poor. Yeah. So, if you were doing endodontic and restorative work that was going to fail in a couple of years, the dentists were not going to ask so much money. Right. But nowadays, we are really able to do something that it is going…

[00:34:03] [SPEAKER_00] I don't want to say that it will last forever. But it is very close to us forever. Very predictable. Or however, it's very predictable on the long term. So, the problem is that the fees are not aligned with the quality, with the biological void that you are going to deliver. Exactly right. So, the main step is that we have to understand that we have to align the fees with what we do. Yeah. Of course, if you are not profitable on restorative work, we have to work two hours for doing something and your revenue is almost zero.

[00:34:33] [SPEAKER_04] Yeah.

[00:34:33] [SPEAKER_00] And in the same amount of time, you remove two teeth, you place two screws in the bone and you get 20 times more. Yeah. Over the time, especially with the economical pressure that we live nowadays in the modern society, we will start to do the wrong choices. Yes. We will push it in that direction. So, the main key is how can I save… This is what I've been discussing yesterday. How can I save teeth in my life and be economically sustainable for my office?

[00:34:59] [SPEAKER_00] This is the way in which you have to change your environment, your office in order to arrive to the goal. Yeah. Because if you are not able to align the sustainability of this kind of choice with your work, you are going well after a while.

[00:35:12] [SPEAKER_02] Yeah. Something you said too is basically in many cases with you, you showed some really spectacular… Some cases that I am certain that many folks in the United States would have seen that case and said, That's an unresorable tooth. We've got to take that tooth out. Of course. And you were able to do… You did some endodontic therapy. You did some orthodontic extrusions in a lot of cases. You used some bio… Like, bio clear concepts to actually make the core. Yeah. Knowing that, yes, this tooth is going to eventually need a crown.

[00:35:41] [SPEAKER_02] But the reality is, is you're… I saved the tooth. You're going to great lengths to save the tooth. And the amount of time and effort is so different than take the tooth out and place an implant. But, like, the value of that is… Okay. For one thing, the value of being able to save a tooth is pretty interesting compared to…

[00:36:03] [SPEAKER_00] Yes, but I did the calculation so that in my office, when I save a tooth in that way and I put an implant, my revenue is the same. This is what I did.

[00:36:11] [SPEAKER_02] That's how you need to look at it.

[00:36:12] [SPEAKER_00] This is the reason because when I have a patient like this, I am perfectly fine. Because I am not to feel, if I save the tooth, I have to feel the idiot. Yeah. I've been an idiot to do this work. All this work for what? Yeah. It's so good. In my office, to save a tooth with orthodontic extrusion needs something like three hours of work in 70 days. Yeah. And the price is the same price of an implant plus extraction and a small GPR. Yeah. The same price. Yeah. The patient is, of course, is able not to accept.

[00:36:40] [SPEAKER_00] But if I give my informed consent…

[00:36:43] [SPEAKER_04] Yeah.

[00:36:44] [SPEAKER_00] …because this is what I would do to myself… Yes. …to my daughter…

[00:36:47] [SPEAKER_02] You're taking responsibility? Yes. Well, if it was your tooth, this is what you'd want, but you're also taking responsibility for the treatment. You're saying, I can do this in a way that we can save this tooth and it will be literally worth the same to you as the implant.

[00:37:00] [SPEAKER_00] Because this is what I would do if the tooth would be mine. I really believe in what I do. Yeah. And this gives me the strength to give this kind of proposal. Yeah. After what I did, I believe in this. I have to make this sustainable for my office. And so over the time, of course, not in one day, but over the time, what I did, I've been changing all the prices of my office in order to align the value of what I do with what I want to do. Yeah. This is what I did.

[00:37:26] [SPEAKER_02] That's fantastic. The worry I have, of course, is that the skill set to be able to save teeth is around here getting lower and lower. Because, I mean, it takes a skill set. It takes understanding of what needs to be done. Of course. It takes literally the ability to do it. And, I mean, like you're doing multidisciplinary work there, all that stuff. And I think it takes a lot to be able to do that. And I think there's a… I don't know that that worries me the most, maybe.

[00:37:53] [SPEAKER_02] Like, if we're not saving teeth because we just don't really know how or we're not very good at it, that's the wrong reason not to save teeth, right? Yeah. I don't know.

[00:38:02] [SPEAKER_00] The point is that we have to give more focus on these kind of techniques. Instead, I see that when I talk about something like this, a few people are really interested after a while. Yeah. Because for them, the implant is always the most profitable and the fastest procedure. And in their mind, it's pretty… But this is not the reality.

[00:38:21] [SPEAKER_02] Yeah. No, I agree. I agree. And just so you know, Marco has… He posts tons of cases, Facebook, Instagram. I'll put a bunch of places where you can see what we're talking about here because it's pretty important that they know what you're talking about. I just… I found the whole conversation very interesting. My pleasure. And I'm interested in… I'm psyched about the book. Really psyched about… I didn't know I was thinking about going to Italy next year. And I'm thinking now hard. That's really cool. So I'll put all that information. Marco, it was a pleasure to talk to you again. We'll have to do it again.

[00:38:49] [SPEAKER_02] We'll have to do it again sooner than nine years. But that was fantastic. Thank you. No, no.

[00:38:53] [SPEAKER_00] We'll do it before.

[00:38:54] [SPEAKER_02] Very good. Very good. I hope… Maybe we'll do it in Italy. Yeah.

[00:38:57] [SPEAKER_00] Okay. Next year in May.

[00:38:58] [SPEAKER_02] Okay. Sounds good. Thank you.

[00:38:59] [SPEAKER_00] You come to the Injection Show and we do another interview. All right. Perfect. Because we have also other speakers.

[00:39:03] [SPEAKER_02] That will be even more interesting. Fantastic. It's great to talk to you.

[00:39:07] Thank you.