Very Dental: The Full Arch Dilemma with Dr. Wade Pilling

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

[00:00:26] Now, here's your host, Dr. Alan Mead. Very Dental people, welcome to another episode of the Very Dental Podcast. I'm your host, Dr. Alan Mead. Joining me for the first time, not on the podcast network for the first time, because he's recorded with Zach and Kevin for the first time with me, Dr. Wade Pilling. Wade, how you doing? Thank you. Glad to be here. So, Wade is... I've known Wade on and off and from a distance for a while because he was a DentalTown guy.

[00:00:55] He was a DentalTown. We just figured out he came on after me, amazingly enough, because I started on DentalTown in 2002 and was essentially obsessed with it for, oh, 10 solid years, probably before the rest of social media came on. But you were around... I knew Wade mostly from his helicopter skiing antics and those sorts of things. So, reflect on your DentalTown time a little bit, Wade. I'm curious what you took away from it.

[00:01:21] Well, it was a great platform for a while. You know, a lot of good information. You know, I learned a lot, right? You had some great clinicians in there, and if you sorted through the BS and the Peacock, you know, there were some great clinicians in there posted some great stuff from endo to implants to extraction stuff. You know, and so it was some great threads, you know, but a lot of people on there contributed. It was kind of great. But just like all things, they kind of slowly devolve. A hundred percent.

[00:01:51] A lot of... It was... You could be anonymous, you know, which was... We're seeing that on Facebook now. You know, it can be anonymous. And it just created an environment that just became, you know, a little bit more hostile, you know. And then leaders try to mediate, and they mediate incorrectly. And it just kind of created a poor environment that eventually, you know... It's funny. I would have left, but they just kicked me out. Yeah. I didn't get kicked out, but it was almost. It was an almost thing because...

[00:02:19] And it had to do with the podcast later on. It was wild. As many things, I want to say... I can't remember exactly what it was, but it was ugly. I mean, I still go back there now and again. But... And as a bulletin board, it's still going. It's still... But it's so funny because it was kind of social media before social media a little bit. And I mean, honestly, I still know a lot of people that I knew originally from Dentaltown there. It's kind of wild. Yeah. Some great people.

[00:02:45] Yeah. I'll say that... So you said that you were still in dental school when you started Dentaltown. Yeah. I think it was like my senior or junior year. Howard Franz spoke at our Louisville Dental Society meeting. And I was like, oh, cool. And I was like, so what's... I didn't know how your computer worked, though. I didn't know how the internet worked. I think I might have had an email at that point. I didn't have a cell phone. Yeah. I think I had an old laptop stuffed away somewhere, you know, that I got somewhere, but didn't know how to turn on.

[00:03:14] And so I, you know, went to the school computer and signed up. Nice. Nice. And joined. It was actually probably my first experience on the internet outside of, you know, an email. Yeah. That's funny. Which I barely knew how to use. I remember in dental school, like the first email I had, I graduated a little ahead of you. I graduated in 1997. You were 2005. Is that right? Yeah. Okay. So I had an email at the University of Minnesota, but like there was nothing that was graphical based. It was all like text based stuff.

[00:03:43] So we didn't really use it for very much. I remember getting a 1200 baud modem for my room at the Psi Omega house. That was when technology was really taken off, a 1200 baud modem that I could dial into the University of Minnesota. It was something. It was really something. That's the good old days. Well, Dentaltown was really important to me at the time. You came on around a similar time anyhow. And so you graduated from Louisville in 2005. Correct.

[00:04:12] Now I look at you as basically, and this is my words. This is not what Wade would say, but I look at you as sort of the quintessential big case dentist. You do a lot of dentistry that's a lot of aspirational stuff for kind of regular meat and potatoes dentists. You do a lot of cosmetic stuff. You do a lot of surgical stuff, all that stuff. But you graduated in 2005. How did you know you wanted to start doing the big stuff? Did you have an idea? Because you didn't go, you didn't specialize. You didn't become a prosthodontist. You didn't do anything like that.

[00:04:42] You know, my junior year, I pretty much got almost all my senior year requirements done. You know, I had that one patient that showed up, actually showed up, and did everything. Yeah. You know, the requirements weren't big. So I got to spend my, pretty much the majority of my senior year from summer externship all the way through my senior year with a local prosthodontist who taught at the school one day a week. And he brought me into his practice.

[00:05:06] And I basically worked with him in his practice doing big cases, mostly arches of teeth, veneers, implant cases, combo cases. And I just fell in love with it. I mean, I was, he pretty much used me as his associate. He would just like give me all the cases that, you know, he gave the guy a discount or whatever and said, hey, you go in and do it. This is amazing. And I'll check on it. This is amazing. He was making money off me, I'm sure. Sure. Right? And so, but he mentored me through the whole process.

[00:05:34] And, you know, my senior year, I actually attended some Hornbrook group courses, some live patient courses. And I just, I felt like the concepts made sense to me. I enjoyed it. It was the type of dentistry I wanted to do. And so from that moment forward, I thought about doing a PROS residency, but I talked to a lot of PROS residents. And even the PROS doctor always says, nah, don't do it. Like they're not surgical based enough. The future of PROS is really just a GP going through the courses and learning and you can

[00:06:04] learn to do everything we can. And you don't have to go through the dentures and the lit reviews. So, you know, he convinced me not to. And, but it did take a lot of education after school to kind of play catch up on that. Yeah. And especially from the surgical aspect, but I just got, I got hooked on it. I felt like I was good at it too. That's remarkable. One of the things that, so basically you couldn't, whatever you pay for it, paid for dental school. You couldn't have paid for that kind of education, being able to like sit in a, in a prosthodontist office and work with them.

[00:06:34] I mean, honestly, you just couldn't have, but I have to tell you, there's some similarities. Our friend, Justin Moody was done with his requirements his junior year too. And basically spent most of his senior year. And he was, he was thinking to be an oral surgeon if I remember correctly. So he spent a ton of time in, in the surgery department at Oklahoma and Danny domain did that crazy. He did a residency in New York. It was, I think it was NYU or something like that. It's like, it was like, basically he just did everything like everything.

[00:07:04] And so you guys came out of dental school, not only knowing what you wanted to do, but having had a lot of actual experience at doing this stuff. That's, that's remarkable. And, and of the, you know, of my friends and people that I know somewhat, you three are the guys like, okay, these guys are really heavy on this stuff. And, and, and I didn't know that about you three until right this moment, you guys kind of had really early on really good experiences in training. That's wild. Yeah. And all three of us are great friends. Yeah.

[00:07:34] No, I was just gonna say, by the way, that you guys all know each other, teach together, all that stuff. But that's remarkable. That is like, honestly, if there's dental students listening right now, I don't know if that's something that can be done in dental schools now, but doggone man, that's, that's a lot. It's hard. I get dental students reaching out to me just like wanting to come get exposure and I'm all for it, you know, cause that's what like this doctor did. That's what Dr. Hornbrook did for me my senior year. Let me come and participate in a course.

[00:08:02] You know, down at Pathway, I've had seniors from the Arizona dental schools, just like, Hey, on your day off Friday, get it off, come assist, observe, you know, and I've had a handful of doctors take advantage of that. As we'll probably talk today about this topics we want to talk about. I'm, I'm big into mentorship because I don't feel like you're going to be your best without it. No, I, at least, at least in this realm. It's, it's an excellent, it's an excellent topic.

[00:08:28] And honestly, um, I'm not sure dentistry as a profession is very good at mentorship. I think, I think it's, uh, I don't know if it's that we're just like not socially equipped to do it or it feels competitive or I don't know exactly, but I just feel like mentorship is not, we're not great at that in dentistry. I don't think. No, it's, it's not. And, and someone who wants to be mentored, you need to realize you got to pay for it. Yeah. If you want the best mentorship, you really got to pony up unless you're lucky enough

[00:08:58] to meet with someone. And, you know, I'm very pro mentor. I don't even think I'm a great mentor. You know, I, I sometimes find myself shooting from the hip, you know, and I really just need to get more organized, put more content. I, I've actually put more effort into now, uh, my mentorship stuff than I have my lecture series. Um, because I think as mentors, right? Yeah, I want a mentor come. And then we get a mentor. You don't know what to do with them. You're like, I don't know. I just told you what to do. Yeah.

[00:09:25] And so it just needs to be more organized if you really want to be it. A person needs to work on being teachable. Cause I have to say, I'm not, I'm terrible about that stuff. I don't want to take, I don't want to take advice from anyone. And I don't know exactly what that is. In some parts of my life, I have no problem with that, but somehow or another, I just bristle at it. And I don't know. I think dental school broke me in a lot of ways. That might be one of them. I don't know. I'm not exactly sure, but, but it's, I mean, finding a mentor is hard enough, but also

[00:09:53] being teachable and being willing to, to, you know, kind of submit your ideas to someone who's done it more is a big deal. And it's hard. It's not, I don't think it comes naturally to people. No, no, it does not. Have you run into people that wanted mentorship that once you started mentoring them, that you, you, they were like, maybe not as teachable as you had hoped? Absolutely. And I had some that have been great and they're humble and they want to learn their young nigger. And I have some that just like, yeah, I already know that stuff. Yeah.

[00:10:22] I was like, I was like, dude, I'm teaching at you and I can even learn something here. You know, like there's, I even want mentorship on this part of the process too. Right. Like, and I've been doing this all the time. And so I think the second I hear someone say, yeah, I, I'm pretty comfortable with all that. I've done 20 cases. Like just, just focus on this for me. I'm like, okay. That's so funny. But the funny thing is too, is I'm like, I've done 2000 of them and I still could use some mentorship. Exactly.

[00:10:48] You know, I, this, I hate to, I, because everything always seems to fall into a 12 step in recovery with me. You get people who come in brand new, like congratulations, by the way. Thank you. Thank you. I thought I read on your Facebook 23 years. 23 years last Friday. That's amazing. 23 years in a week, we'll say, because it's a Friday they were recording. In any case, like what's funny is, is people come in feeling like, first off you come, you feel really good when you've stopped.

[00:11:17] Like, like there's a pink cloud for new, newly recovering people. But then I see people talking about, oh, I get this and I get this and I get this. And I'm like, just slow your roll, dude. Just like, what's the rush? It's wild to me. And I can say that from, from a 12 step perspective, but I think I'd probably be hard to, I'd be hard to mentor. Cause I'm, cause I'm, I think, I think maybe I think too highly of my own understanding of things sometimes it's, it's a, it's a weird thing. I wouldn't have expected that our conversation was going to go this way, but it's true. Yeah.

[00:11:45] No, being, being mentored is, is difficult. I mean, social media is ruined it for us. I mean, we've got the docs coming out of school and within one year they want to open a DSO full arch implant practice and they're just ready to go. Like I've mentored people that on their very first implant, you know, and told me the next day they're opening up an implant center. Yeah. Right. And I'm just like, oh my gosh, you know, and you know, I've, I'm a mentor docs that come right out of school, go right into a DSO, you know, implant center.

[00:12:15] And then they have complications galore and they don't care cause they're just going to move out. They're using that as a stepping stone. So, you know, we, today, you know, I've just, I'll just kind of preface my comments are just opinions of mine. Yep. And everyone in this space has opinions and strong opinions and they should, and that's fine. Some of them probably better than mine. My opinions on here, I'm not going to speak about anyone specifically. If you feel like, like I'm targeting you when I'm saying some of my opinions, I'm just

[00:12:44] going to tell you, I'm just telling you my observations. You might be the exception and there are exceptions. My experience is everyone thinks that are the exception. Yeah. You know, when it comes to this. It's so true. So take that out of the grain of salt. But my views on this field that we were talking about come from a career, 20 years of being a full arch practice, a big case dentistry practice, very little if any GP work. And it comes from a perspective of clinical excellence.

[00:13:12] I've had, I've been lucky enough to have a career where I didn't care about money, didn't focus on money. I've never once set a goal or looked at a number in my practice, maybe once or twice a year, like, oh, are we up or down this year? Okay, cool. Whatever. Next. Right? I'm not about the numbers. I'm not about the money. I've been lucky enough to, you know, grow up in a market and where focus was 100% clinical dentistry and the money would just follow. And I couldn't even tell you how much money I've made in dentistry. I don't pay attention to it.

[00:13:40] So my comments are going to be strictly from what's clinically great for the patient. I know we have to balance what's good for a practice, but I'm just going to, they're going to be mostly focused on clinically what's good for patients. I want to dig into that. But with that said, are you in a position where, okay, are you in a position where patients seek you out at this point? You're not, you're not, you're not marketing for, you know, the, the young family with,

[00:14:06] with kids for a hygiene, you know, like a, like the regular bread and better stuff. People seek you out because they've got hygiene. Right. You're essentially, you're essentially like a pros practice on some level because you're not, you're not doing a bunch of general dentistry. And let's be honest, there's different kinds of patients out there. I got a, I got a practice full of patients that are like that, that don't have a lot of needs. Someone's got to see those people, you know, but, but it doesn't make sense for them to go to your office. I mean, it doesn't make any sense for them to go to your office.

[00:14:33] No, I have a partner who has a GP practice that sees all that. Yeah. I would say 95% of my patients come in for a consultation. I basically run my practice like a plastic surgeon. I have a, you know, I have surgery ops and procedures going on. And then I have a whole column full of consults. Okay. And my receptionist does consults all day and I pick my head in, give a treatment plan and she weeds them out and, you know, from there. So it's really, they come to me. I don't see patients do hygiene.

[00:15:01] I mean, hygiene, I mean, if I were to run a number, it's probably 5% of my practice. It's, it's more of, yeah, like a process and that comes direct to marketing to the patients. I get a lot of referrals from doctors. I get a lot of referrals from doctors out of state, you know, since I do teaching like a big chunk of my patients are either treating doctors, doctors, spouses, or their parents, right? Or, or they'll send me their parent or a patient, but they want to come watch and learn because I have an open door. You refer to me, you get to me.

[00:15:31] You get to come and watch and learn. We'd make a little CE out of it. And so, you know, yeah, it's more of that style of practice. What you do is, is probably a dream and an aspiration for a lot of people. But the other thing is, is that it's not realistic for, for, for most people. You have sort of created this and this is, this is sort of what's happened. I, I, in other words, I'm not saying it's great or it's terrible, but I will say that probably people ought not plan on being able to do what Wade has done. What, what are things before? I don't think people should try it. Not in this market.

[00:16:00] It will be with the debt levels. You come out with the incentive structure now. Absolutely not. I, I, very few people can do it. Yeah. It's a different incentive structure right now. It was a different time when you started doing it. You also had a lot of background in Full Arch coming out of dental school. So you didn't have to, you didn't learn bad habits, you know, with your first job or what have you. Did you, did you open a practice? Did you buy a practice when you? Yeah.

[00:16:25] So right out of school, I, I got a building, uh, land, started building a building. And so for the first nine months I associated somewhere, you know, just kind of a corporate mill office while the building was being built. And, uh, so my building was being built. It was just gonna be a scratch startup, you know? So I just, yeah, I was kind of alone associating in a corporate tile office. I ended up leaving cause I noticed some shady stuff going on. So I left a couple months before my building was open cause I didn't want to be associated

[00:16:54] with some of the stuff that was, people went to jail. You know, it's a whole nother story, but like office manager, embezzling, fraud, stuff like that. I could sense it just being an associate. So I left and was kind of unemployed for a month or two until my practice opened up. So I kept busy though. I, you know, went, did some CE work. I put my own fence and sprinkler system in my yard, you know, became a landscaper for a couple of months. Why not? Right. I mean, okay, but you had, I mean, you had a, you had a vision from the beginning. You knew what you wanted to do.

[00:17:23] And would you say that your demographic, where, where'd you build the building? What town is it? Uh, it's in the Boise, Idaho area. Boise area. Okay. A suburb. Would you say that the demographics were really a pretty good, you were in a good position. It's not like you were worried that you were gonna, you were going to be starving. No, this, this place was one of the fastest growing areas in the country, you know, mass migration in this area. Uh, land was cheap, you know. Um, money was cheap. You know, I think I had 0.7% on my student loan. Yeah.

[00:17:53] You know, it was back when they just gave everything for free. So it was like, why not? Right. You know, the guy built my building and carried the note for me for a year till I could take over it. You know, everyone was just, it was an easier time. Yeah. Right. And then, and then, uh, you know, the crash happened in 08 and that was a pretty big hit, you know? Yeah. I'll bet. I'll bet. Yeah. So then, okay. So you, I mean, I wasn't going to just do the deep dive on, on Wade, but your, your story is so interesting.

[00:18:19] And I will just remember listening, everything that Wade did, you probably can't do now. So just enjoy the story, but it's really, it's really a different time. You're not going to be able to do this or it's going to be really hard to do this. So when you, what training did you do? You got out of dental school, you did a scratch startup and you knew the, you, you weren't from Boise. So how'd you pick Boise? How'd you pick your area? Well, I'd lived in the U S since college and I just want to move out West. My wife's from California.

[00:18:46] I had some family that moved to the, you know, parts of Idaho, Utah, and I liked the mountains. And so I knew I wanted to be out West. So it was either Montana, Idaho, Utah, you know, maybe Arizona, Colorado, you know, so I needed to be in the mountains. And so Idaho looked like the best demographics. Yeah. So you did the demographic family. See, you're in a, that's the one thing that's really funny. Well, one of the one thing, one of the things that, that kind of the stars align for you

[00:19:13] is that you were in a position to, you were in a position to, to choose a good place to start. You, you weren't committed to a particular place for starters, which is great. I mean, like, cause there's people out there that can show you the demographic hotspots and you can go to them. I mean, that's the, that's, that's what I would recommend. But so many people are, okay. If you go to the university of Michigan for dental school, guess what? You probably want to practice in Ann Arbor and guess what? There's a lot of damn dentists in Ann Arbor.

[00:19:41] There's a ton of, like the whole Metro Detroit area that, I mean, there's just, there's, there's people that need dentists, but man, that's a, that's a tough place to go where you were looking at Boise and it was a, it was a positive market for, for your kind of startup. Is that right? Yeah, totally. A good, good, good growth. I mean, I, I built on the outskirts in the middle of a farm field and I'm pretty much in the middle of the city now. Wow. You know, I mean, I'll drive around the corner one day and I'll see a new Costco, Walmart and 5,000 homes. I'm like, when did this go up? Yeah.

[00:20:11] Yeah. You know, it's just, it goes up like crazy, but, but yeah, the, it was, I wouldn't recommend people doing what we did. You can't do that this way. When I graduated, the incentive structure for me was debt payment. Everything was low. Right. So I didn't care about money. My incentive structure was to do the best dentistry I could. So my incentive structure was to go seek, you know, the best training from the best people where now there's a huge incentive structure for, for money. Yeah.

[00:20:37] Not just because inflation, things cost more education debt. Yeah. You know, we'll talk about that, but that incentive structure is directly, you know, resulting in the problems we're seeing. I agree. So one last thing before we get to the guts, the juicy stuff, what, where did you train? Just give me a, give me your background. Where'd you learn to do what you do? So, um, you know, mentors, number one, you know, I went through like pretty much the whole Hornbrook group continuum. Love that guy, you know, still stay in touch with them.

[00:21:06] One of my favorite interviews I've interviewed him multiple times. He's literally one of my favorite interviews. I ran into him at the midwinter on the floor and asked him, he came, he just came over. We record again. I'm hoping I run into him. He's just, he's a great guy to talk with. He's awesome. Yep. Yep. Tons of experience. Uh, went through a lot of spear stuff. You know, anytime I could see spear Corey speak in a conference or whatever, I would go to it. Um, you know, we didn't have the continuums like we do now. No, they didn't exist in the same way. Yeah. Yeah.

[00:21:36] I mean, uh, Frank had a little bit of a one. I went to spear, but, but it was like at hotels. It was like, it was up and running in 2005. I was there in 2005. He was, he had, but he's even refined the, the continuums different now than it was when they started. It's still, it's pretty consistent, but yeah, that was just starting at that point. And yeah, it was, you know, and then some implant centers like white cap was kind of popping up and I'd go to some of their stuff. And so I pretty much had to hodgepodge, you know, everything I could traveling around.

[00:22:04] What they didn't have was an implant pathway where it was literally live patient and whatever kind of training you want. That just didn't exist. And of course that said, that's our friend, Justin Moody and, and Wade teaches over there and, you know, in, in, of course, Moody has, has created that thing and it's changed and gotten bigger. And so it's a, I mean, it's, it's pretty much the place you go now. So on some way, there's nothing like it. You, you had to cobble together your, your training where right now you don't have to

[00:22:32] cobble quite so hard because there's a lot of good places to go. Exactly. And, and my training still goes on. I mean, I started, I don't know, seven, eight or so years ago, uh, Justin Moody recruited me to come help him run some, a pathway and mentoring. And it, it developed an education and director of faculty and, you know, one of the head mentors there. And, but I also got to rub shoulders with some great clinicians too. Right. That I got to hang out and teach and talk and learn from, you know, Justin, Dan Holtzclaw,

[00:23:01] you know, uh, Chris Barrett, Rod Schaaf, you know, there's, uh, Josh Nagel now and, and others. And we get to, you know, learn. And a lot of that is be having access to other great clinicians. We share cases, we see their stuff. I get to watch them. They get to watch me, you know, and it's, that's been crucial to being part of some type of, you know, organization when you do these types of cases to, you know, see the problems they're having and how there's, you know, their solutions. Yeah.

[00:23:27] If you're smart and you want to learn this stuff, you get to be friends with these guys and ask them what to do. And they can give you an idea where, where to go for training. I mean, we mentioned Danny domain and, and, and Corey Glenn and there's, there's, we've, we got cool friends and they're, if you want to learn it, we can probably point you in the direction to how there's a lot of different stuff going on there. But so one of the things, the thing that I, this was fascinating. I didn't expect us to dive, you know, dive in so much on your background, but it does help.

[00:23:56] It's helpful because part of it is people need to know what you, what you did to put your training together. Part of it need to know is that the, unfortunately the, the world isn't the same as it was when Wade kind of hit the ground running. But no, and they need to see where I draw my opinions from and what I've observed. Right. So, I mean, we've talked about it ad nauseum on the podcast, the student debt problems and how kids are coming out. Like I got out of dental school with $85,000 in debt and thought I was in deep trouble.

[00:24:24] And it was, you know, like that's nothing. So, you know, now it's, it's, it's not unheard of four or five, $600,000 in debt for dental school alone. You know, and so all of a sudden these kids are, I say kids, God, that's so condescending. I'm sorry. These young dentists are facing stuff that on a, on a level that I, we didn't really understand. And not only, I mean, not only do they have a lot of debt, but then they've got a lot of

[00:24:50] pressure to, it's, it's much harder to go into an associateship situation where you have a mentor and you're eased into things. You can't ease into anything with that kind of debt. So tell me, just give me your, your opinion and, and how you're feeling about, you know, the, the, just the landscape for a new dentist hitting the ground. What, what's, what are the concerns they have? What are you seeing most people doing to start and, and, and how are the incentives affecting them? Wow. Okay.

[00:25:17] So yeah, overloaded with debt, the debt structure is too much. I don't, most of the doctors coming out of school with that much debt are going to have to pay it. And that's going to, so the incentive structure is money at this point. Yeah. Right. And not that money's a bad incentive structure, but when it becomes the priority, you're going to be in DSOs, you're going to be over treating, you're going to be in mills, you're going to be, you know, pushing more dentistry than you should. Right.

[00:25:45] And that's, you know, and you might chalk that, well, I'm getting lots of good experience, but at the same time, are you right? I also think that there's people like fit 30 crowns a month at, you know, an Aspen dental or whatever, does that make you good? No, I don't think volume makes you good. Necessarily. Reps don't make you good necessarily on some procedures. They can, they don't necessarily, but I'll also say that I think there's a lot of dentists at DSOs that would say, no, I'm not over treating. You're just, others are under treating. I'm treating what I see.

[00:26:13] And I have to tell you that I'm old enough. I'm pretty conservative about some of my treatment planning on that level. So a lot of what I see or hear about from DSOs makes me bristle. I tend to be more of a, I tend to think of it the way that you just described. Maybe not fair. I don't know, but I'm perfectly okay with your opinion. I tend to lean into exactly what you just said. I think there will be people that find that a bit much or a little offensive, but I guess I don't care.

[00:26:39] I'm sort of like, you know, our DSOs, who's more likely to be in a position to be kind of over treating and over pushing stuff. We just know, let's not pretend that we don't know what's going on. Okay. Exactly. And especially when we're talking about the full arch, you know, atmosphere. So, you know, my practice is, you know, I teach full mouth reconstruction on teeth. I teach full mouth implant, you know, digital workflows. I teach FP1. So I teach full arch stuff, whether it's implant or so people come into my practice, they don't

[00:27:07] get shoved into full arch implants or teeth or combo. They go to whatever. I get the right diagnosis. And so I'm not motivated to shove everyone to an all on X, right? I'm still saving a lot of teeth. I would say half my arches are still on teeth or some type of combination of them. But, you know, these come out with a lot of debt. They see like the money that can be made in the full arch game. And we've got docs just too new jumping into it and eventually in too many people and get

[00:27:37] and that's their incentive structure because that pays well. And it does until the lawyers step in, until the failures happen. You know, I always say the best, you know, if you're a really new, good all on X dentist, move every five years, right? So you practice and move every five years. You have a great career. But, you know, and I'm seeing it. I'm seeing in my own practice, revision cases, you know, from docs that are just getting in over their head or doing things too sloppy and quick because the race is to make money,

[00:28:05] you know, or to grow a DSO and sell it. You know, the incentive structure isn't to do your best dentistry. And that has to do with the debt, right? They come out of school with a lot of debt. And I get it. I'm not, I can't have, I didn't experience it. So I'm, I don't know how you feel, but it is a lot. It's a big debt at a big rate. You know, I, I wish school would be changed to two years of school and two years of mentorship in an office, you know, like, you know, you spend your last two years of dental school

[00:28:33] in a, you know, a dentist's office doing an apprenticeship of some sort, you know, kind of more of the trade model. Yeah. I mean, I, I talk with my best friend from dental school about this all the time and it's like, yeah, dentistry would be a much better, would be much better served with an apprenticeship kind of, not, not that anyone, not that any kind of education is happening that way now, but it would make a ton of sense. It would make a ton of sense. I mean, because the clinical aspects of dental school, I mean, okay.

[00:29:02] So my dad who graduated in 1968 from the University of Detroit couldn't believe how little clinical experience I had at the University of Minnesota when I graduated in 1997. And, and now what I had for clinical like background at Minnesota is far in a way what, what a dental student will see in dental school now. And they, I think how much more they're paying for it and how much less actual experience they're getting. It's just that those numbers are not going in the right direction. There's no doubt about that. No, the reality is when they get out, they got to produce. Yeah.

[00:29:31] Unfortunately, you know, jumping in, you want a debt, you jumping into full arch implants right away to try and dig out of that hole. It's just creating another problem. It just doesn't put the patient care first or even close to the top. It puts the incentive structure on money. Well, and some of the marketing for, let's just, I mean, I got to say this first off, even full March, full arch rehab. Okay. Like rehabs on teeth are hard enough and, and there, it takes a lot of skill in treatment planning.

[00:29:59] That takes a lot of skill in, in frankly, in informed consent and that sort of thing. And I'm thinking to myself a year or two out of dental school, I, I wouldn't, I mean, I would have needed a lot of help with that. Like just understanding that. And mind you, I'm, I'm slow. I mean, there might be some real go-getters that are new that could get this, but man, it's like, you gotta, you gotta fix some teeth. You gotta, you gotta, you gotta do some stuff to kind of even know. I don't know. I just feel like when I hear you say a student comes out of dental school and they're, they're in a DSO that's doing full arch.

[00:30:28] I'm like, Oh my God, Hey, prep a couple of crowns or something. Would you? I mean like, yeah, you can't do full arch implants until you can do full arch teeth. I agree. I promise you that. I agree. There's a couple unique weirdos that can do that unicorns. But like I said, if you don't know how to build a vertical, like for example, just, just yesterday or two days ago, you know, had a case all an X done came to me. Uh, I, for revision, right. I did her husband. She has a problem. Um, um, the vertical was set incorrectly. The smiles incorrectly.

[00:30:56] The multi, I mean, no restorative consideration at all. The implants were okay. I mean, not great, but no soft tissue considerations. All these things you learn in full mouth reconstruction of teeth about periodontal, you know, stability, bone stability, you know, where teeth need to be, where the vertical needs to be. Right. People think they just take a face scan, send it to the lab now and they do it all. Right. The technology has made our life easier and harder at the same time. Sure.

[00:31:22] Um, technology has taken away people's ability to diagnose. No one diagnoses anymore. Uh, they just, they take a scan, a couple of photos, send it to the lab and let the lab do their thing with Exocad. Um, I can tell you as I do lots of expert witness cases now, um, and I'm always looking for the diagnosis in their treatment. There is no diagnosis 99% of the time on these cases. They're like, I don't know. I patient wanted implants. And so we did this and the lab did this and now we're doing implants. There was no diagnosis.

[00:31:52] There was no records, you know, properly taken that you'd learn in a full mouth reconstruction process. And you learn that full mouth reconstruction starting with dentures, right? You know, you've got to learn how to set denture teeth and how to set a vertical stuff at dental school. You didn't pay attention to. Right. And then it translates the prepping teeth with dentures. A lot of them didn't do any dentures. They did. I mean, in dental school there, are they, are they doing dentures? Are they, are they setting teeth? I don't even know. I've got it. I sure hope so.

[00:32:20] I, I set a lot of teeth in dental school and I'm not going to pretend that I really had a handle on it even through that for crying out loud. I mean, like it, but, but it is, it is an important, everyone always says that. And I think to myself, and part of our problem is I don't even know that dental schools talk about that stuff anymore. Like, I don't even know if they do that. That might be true. That might be true. But yeah, there's just, there's, there's a progress that needs to happen to learn. And we're just, we're thinking technology skips us to the end. Yeah. You know? Yeah.

[00:32:48] And unfortunately we're seeing the problems with it. Seeing cases treated that shouldn't be an improperly treated. Yeah. What's, what's the most common thing that you're seeing? I got to tell you that when you, when I hear revision, okay. In a lot of cases, they're taking away a bunch of alveolar bone to make room for materials, to make room for, which I understand sometimes that's what needs to be done. But the problem is they got to think really hard about that.

[00:33:14] How do you do informed consent for a patient to like chop off half of their alveolar bone, which they can't get back. They can't get that back. It's gone. You know? And when you're talking, when you're talking, you know, in 15 years, if this needs to be retreated, what is there to retreat? There's nothing there. Like what, like, so I'm just, I'm blown away. Like I think about this as a, you know, I've been in dentistry for 27 years and it makes my head spin. I cannot imagine someone being super excited to get out the saw-saw and just do that. Like, especially if they don't know anything.

[00:33:41] I mean, you've gone through enough of this stuff where you understand when that may or may not be appropriate, but tell, talk to me about that. Yeah. So I, I try not to like armchair quarterback cases too often, but if you, there's only one diagnosis, there's multiple treatment plans. But to me, if you diagnose the case properly, you know, if you do an FP1 or an FP3 or, or whatever after chop bone, that's kind of secondary. But first you got to get the diagnosis, right? Which is terminal dentition, right?

[00:34:10] And there's some good articles and stuff out there that about terminal dentition. But if you don't have the diagnosis of terminal dentition, you should not be full arching this case, right? And so you got to get the diagnosis right. Then from there, you need to diagnose where the smile line is and understand, you know, where is the transition zone? Is this an FP3 case? I teach an FP1 course, but I don't believe every case can be FP1. But I do more of them. If you can, especially based on the patient's age, right?

[00:34:39] Or if I've got a 75 year old patient, perio disease, I'm not fighting to do an FP1. Right. Because I know a good solid FP3 stabilized with good tissue. It's going to last. It'll probably last this patient the rest of their life. But our full arch patients are younger and younger. I've treated 22 year old girls who've done meth their whole life. And they've got great bone, but their enamel tooth, coronal structures are gone. Right. So we're getting younger and younger patients.

[00:35:08] In the past, those patients could never afford this stuff. But now we're having, you know, younger and younger patients whose parents are wealthy and their daughter or son just got into drugs. Right. And the parents have the money to save those. So I'm doing FP1 on those, preserving bone. No, just the same way I would with a veneer. You know, I've done veneers on teenagers. And I'm like, okay, we're doing no prep because you've got congenitally small teeth or decals. Because I want the next doc in 20 years who does this case to say, guess what? Guess what?

[00:35:38] I don't have to root canal these teeth. Right. And so even, you know, when we, if we take off that periodontum too early, the next guy's going to hate us. Right. We have cases where I'm hoping somebody invents something before this patient dies. Yeah. To save them because I was left with nothing because I had to do a revision. And now, you know, so yes, it's just having a good thought process. I can't tell you how many times I've, you know, sold an FP1 case, closed it, taken records.

[00:36:06] You know, beautiful case, younger patient. And then they Google somewhere and the new guy down, you know, somewhere, you know, or even out of state, you got corporate paces marketing from out of state said that do it for half the price. And they come back to me with a massive FP3 chopped off bone. It just, I just sink. I'm just like, you know, guys, the lawyers will sort this out. But yeah, it's too bad, too, because I don't know.

[00:36:30] I just like on some level, have you found when did when would you say you started doing full arch implants? Like, when did it become a common thing for you? Because I feel like this has sort of snuck into my understanding. Now, mind you, I'm in a different place where there's no one really doing a lot of full arch implant stuff around me. I mean, there's some specialists that work with general dentists around us on occasion for a special case. But it's not common.

[00:36:58] I mean, there are places in Michigan where it's marketed for, but it's not common. So my question, and so I haven't seen a lot of it. Like, if I had to refer something, I don't know where I'd refer it to, to tell you the truth. A lot of times it's somewhere down in the metro Detroit area. It's a couple hours away is what I'm saying. Well, I started getting into it maybe two or three years into my career. Okay. You know, I had just had some cases. You know, most of the teeth are restored.

[00:37:24] You know, but then you start getting cases where you're like, you know, you restore some cases you wish you had it. Yeah, yeah. Because they were uncontrolled decay. Yeah. They come back two, three years later, still getting more decay. And you're like, man, we should have. Yeah. We're chasing our tail here. Yeah. So, you know, I found a need for it. And most of the cases early on were FP1. FP1, because that's what they were doing. Yeah. Yeah. More FP1s, you know, custom abutments, cemented bridges, you know, passive did really well. Some of those are holding up great. Sure.

[00:37:53] You know, I didn't like doing FP3s because at the time it was a bar with hybrid teeth. Mm-hmm. And the maintenance on those was miserable, right? Your teeth were popping off all the time. The dentures had to be redone, you know, on the bars, you know, every four or so years. You know, just the materials weren't great. We weren't playing with zirconia like we do now. Mm-hmm. And so they were, I didn't like them. Most of my implant cases, I tried to do FP1 because I could do custom abutments, PFM bridge. You could do fixed stuff like teeth. Yeah, exactly.

[00:38:23] Yeah. That's interesting. And then as the material started switching into full zirconia, then I started doing more of the FP3s. Because, you know, you start having denture patient populations having the money and saying, I need that. And they just weren't FP1 candidates. Yeah. This is really interesting. So knowing all the stuff we've talked about, what do you tell people that are like, you know, I want to really start making money in dentistry.

[00:38:52] Or I want to, like you said, the brand new dentist who's going to open a DSO implant center and probably doesn't. Where is this going? And what should we do? What do we have to say about all this stuff? Well, I get that question all the time. And I tell them, I say, you know, like if your incentive structure is money, it's going to end poorly. Right? Even if you get money, you'll make money. If your incentive structure is money, you'll get money. But your patient outcomes are going to be poor.

[00:39:20] You're going to be dealing with headaches, you know, of a poor quality dentistry. If your incentive structure is to be the best clinician you can, the money will usually follow. And I understand it's a different environment, but I tell them, you know, get a practice that's making money. Have an associate doing it where you're very experienced. And so you can slowly start implementing those big cases. But you still, that way your incentive isn't financial because you already have a practice that's booming and doing well.

[00:39:48] And now your partner or associate is taking over more of that production. And you can start going and doing more cases, maybe one at a time, one a month, one a week. Then it becomes every day. Right? And it's a slow process like that as you learn, as you go. That way your incentive structure is, you know what? I want to do the best case. I want to do the best dentistry I can. You're committed to quality, committed to education. That's how I tell people to go about it.

[00:40:14] But if you, you know, if you're going to jump straight into this stuff, it's going to end poorly. Okay. So let's add the complication. I mean, we're taking the most complex thing we do in dentistry. And throwing it out to the new kids. Dumb it down. Yeah. Yeah. I'll say this, though. Practices are not owned the same way that they used to be. And that's changing. It's not – I think sometimes we overhype how much DSOs are – but the reality is that it's moving in that direction.

[00:40:41] And that direction probably is not as worried about the clinical outcomes as you are talking about. As you said, I mean, DSOs in general are – I mean, it's about money. It's about money. It's about managing things and making more money from what we're already doing. So how does that affect where we're heading? Well, like who's responsible for those cases and what recourse do the patients have? You know, I do consults all the time where the patient asks me, well, I went here and I went here. And then, you know, I saw this on Facebook.

[00:41:11] I was like, well, what's been your experience in those consults? And they say, well, I actually never talked to a doctor. I just have someone who's been calling me on the phone, got me pre-qualified, diagnosed me already. I'm going to fly into town, have it done. You know, and I'm just sitting here scratching my head. I just say, you know what? And I have to explain this to every consult. I tell them, I'm a private practice owner. I'll always be the owner when you see me. If you have a problem, the buck stops with me. There's no walls for you to get anything fixed or problems.

[00:41:40] That's worth every dollar more that I might charge than them. It is. Because when you get that done, you just have to be aware. And I tell them, I say, you can go there. But when you have problems, they're not going to be able to handle them, you know, likely. Because the doctor who did your case might not be there anymore because he wasn't the owner. He left. He used that place as a stepping stone, an experience to experiment on patients, to learn. Right? With me, you're here. And when I'm done leaving, I'm going to make sure whoever takes over my practice is the same. Right?

[00:42:10] And when you have to come for me for a revision, I charge double. Not because it costs me double. Just I need to teach you a hard lesson. And I'm going to charge you double so you learn the hard way. That is wild. That goes against a lot of what's being talked about. I'll say that. That take is very interesting. And, God, I mean, we've been going for a while. And I appreciate your time. I feel like there's probably a part two to this conversation. But I kind of want to have listeners. Because here's the thing.

[00:42:38] I suspect we're going to have listeners that are listening to this and going, oh, yeah, I feel this completely. And then there's going to be listeners that are like, that's total bullshit. I want to hear from everyone because I kind of want to hear the sides. I feel like the one thing you can say about Wade is he's seeing this stuff. Like, he's actually seeing this stuff. I'm like, I don't see this stuff very much. I hear about it a lot. I hear about what people talk about in social media and all that stuff. But I don't see it like you do. So I think this is an interesting take for sure. So, listeners, if you have any questions or comments, we'll bring Wade into the Facebook group so he can answer and all that stuff.

[00:43:08] And, man, this was really good. So, you know, the other thing that you can like about Wade is he vacations very well. And he does a lot of stuff with his huge family. The last – he's got lots of kids. They're getting to the point where they're maybe making choices about careers. And you know this question. Would you recommend dentistry to your kids? No, absolutely not. Not a chance. Not a chance. I mean, first of all, I have to stay on a while to trade him. I don't want anyone. Well, that's part of it.

[00:43:38] I don't want anyone. In fact, my son was pre-dental. He was two years into the pre-dental. And he came to me. And I thought maybe he'll graduate. Come. I'll train him up. You know, work with him. But he messaged me or called me. He was like, Dad, I've been doing the math. And this makes no sense. It's true. He's like – and I was like, I know. I was like, it doesn't make sense now. Yeah.

[00:44:04] I mean, you're going to dig a hole deep enough that you're going to have to come in and do what I do to dig out of it. And you can't do what I do. Yeah. So what are you going to do? Yeah. You're going to come in and do what I do and hurt patients, you know, because you haven't learned it the proper way, the proper time. You haven't put the time and effort into this. And so he ended up dropping out of college. He was two years – two months into the – or two weeks into the next semester. And he's like, I dropped out. And he joined. And now he's in an electrical apprenticeship. I remember that. He's in his second year doing electricity. He's like, I'm going to be an electrician, Dad.

[00:44:33] I'll borrow my own business. Smartest. He's going to be better than me. He's going to crush it. Okay. So what's really funny about that is that, like, I don't think either of my sons would be interested in dentistry anyhow. They show no interest in it whatsoever. And so I'm not worried about it. But I do have to say, I don't think I could recommend it. I don't – unless you're okay going into the military first and not having – Yeah, that is an exception. That's the story. I mean, and the thing is, is, you know, there's only so many scholarships. There's only so many military people that can go into dental school.

[00:45:03] The rest of them are on the hook for it. So this is – this was enlightening. This was really good. Yeah. And I've got five daughters. We'll see if any of them show up. Yeah. You know, I've got three at home still and three that are graduated. And one's in nursing stuff and the other one's in just traveling the world, you know. Rock climbing. Europe. Yeah, she's in Europe, Hawaii. I used to be in Hawaii right now, South America, you know. So she's still in that travel bug. I get it. I get it. That's cool. I don't think any of them are going to do dentistry.

[00:45:31] You may have wrecked it for them, but honestly, I'm with you. I should probably ask every guest that I interview now if they would recommend it to kids because I think that is an interesting question. Because there's some that are all in on it still. And I got to tell you, I don't think I could either. I still love – I love what I do. Sure. Like that's why I still do it. I love what I do and I love teaching, right? I practice two or three days a week and then I teach the other time. Like, you know, next week I'm flying out to Salt Lake for a couple days to help a doctor. The next month up to Spokane. So I still do a lot of in-office mentoring.

[00:46:01] In fact, my all on X, you know, teaching, I used to teach a course by patient. I'm getting away from that now. I feel like, you know, sometimes as an educator, this can be a whole other topic we get into. Sometimes I feel like, am I just training people to hurt their patients? Yeah. Right? Because you get people in these courses that don't belong, right? You know, my full mouth rehab course is a little different because I feel like they need to learn that early on. How to set verticals, take records, right? That's good for a newbie.

[00:46:29] The FP1 course is great because I get more advanced doctors into it. But the all on X, people just want to watch a YouTube video and learn or have the, honestly, like dental labs will send their assistant to you to teach you how to do it. Right? It's crazy where the education is there. And I'm actually, I almost think I'm done teaching full arch implant stuff on a big scale basis.

[00:46:52] And I'm going more to one-on-one, two-on-one mentoring where I feel like rather than, I'd rather make a difference in one person's career, you know, in a more intimate matter than teach a bunch of people in front of stage and have them go out and try and figure it out on their own. I don't feel like that's helping many people. At least from my perspective, I'm like the kind of guy, I like to have, I like to talk to a bunch of people. I like to talk to one or two people, have a great conversation. You know, it's funny. We brought it back around in mentorship, which is what we talked about very first.

[00:47:22] That's interesting because I feel like that clearly is running through what you do. That's interesting. It's very interesting. Yeah, I find that the doctors who learn the most are the ones that I get like a couple days in their office to get them started and then, you know, follow up maybe another couple days in office six months later. You know, where we line up cases and we do them, we slow them down. And it's just, it's really good one-on-one mentorship as opposed to just standing up and listening to me lecture and seeing me do it on a case. And now I send you on your way to figure it out. Right? And people get in over their head.

[00:47:52] I just, the education of the all-on, you know, Forex or whatever you want to call it market is just interesting. You know, and the marketing is problematic. We can talk about that as well. There's just so many problems. I don't know what the solution is, but I do know that one-on-one mentorship for me seems to get the best results out of doctors. That's awesome. Wade, I'm going to cut us off here because I think we're going to roll in and do something else in a second because there's so much we didn't get to. This was awesome. Thank you a ton for your time, Wade.

[00:48:21] And we'll bring you into the Facebook group. And if you haven't joined the Facebook group yet, go to Very Dental. On Facebook, go to Very Dental. You're going to ask for an invite. There's going to be one of five passwords. The passwords are Timmerman, Lipscomb, McQuethy, Papa Randy, or Hornbrook. One of those five will get you in. Wade will let you in without a password. That's okay. We'll let you in. The Very Dental podcast page? Yeah, Very Dental Facebook. I think all you have to do is go on Facebook and look for – I haven't done it in a while. Let's just see. I'm pretty sure I'm already in that.

[00:48:51] You might be already. Yeah, you probably are. Why wouldn't you be? There we go. Very Dental Facebook group. There it is. Okay, cool. So he's in here. If you have questions, comments, bring him to us there. And we're going to do some more in a sec. So thanks a ton, Wade. You're welcome.