Dr. Dean Vafiadis received his dental degree and Prosthodontic specialty training at New York University College of Dentistry. He is currently the Director of the Full-Mouth Rehabilitation CE course at NYU. He is an Associate Professor of Prosthodontics at NYU College of Dentistry. He has lectures nationally and abroad for NYU Continuing Education department. Dr. Vafiadis published and lectured on various topics such as Aesthetics, Implant designs, Computer restorations, Ceramic materials and Occlusion. He is the founder of the New York Smile Institute in NY. It is an educational center, full service laboratory and learning facility as well as a private practice location for a multi-specialty practice for Implant and Aesthetic Dentistry. Currently he is lecturing for the Continuing Education program at NYUCD for Dental Districts in US, Europe and Asia. His patient base includes many Celebrities, Sports Figures, Fortune 500 Company executives, Producers, Directors and Writers in the film industry, Executives in the Fashion world and World renown Chefs and Restaurant Owners. He maintains his private practice Valentino Building near Rockefeller Center. Dr. Vafiadis primary professional mission is to educate, publish and invent new technologies that will help change the dental profession and patients lives.
VIDEO-DUwHF #1096 Dean Vafiadis, DDS
AUDIO-DUwHF #1096 Dean Vafiadis, DDS
Howard: He are live in Las Vegas thank you so much we are at the huge MegaGen Conference and Dean I gotta tell you these guys got the greatest speakers in the world from Korea Israel Germany Portugal congratulations on getting asked to speak at this event.
Dean: Thank you very happy to be here.
Howard: So Dean Vafiadis think of mafia with a Dis. Dean Vafiadis received his dental degree and prosthodontics specialty training at New York University College of Dentistry. He is currently the director of the full mouth rehabilitation CE course at NYU. He is an associate professor of prosthodontics at NYU College of Dentistry. He has lectured nationally and abroad for NYU by the way of for those who are on the world NYU is the largest dental school in the United States six and a half percent of all the dentists in America graduated from NYU it's that huge and he's not the top dog there. Dr. Vafiadis published and lectures on various topics such as aesthetics, implant design, computer restoration, ceramic materials and occlusion. He is the founder of the New York smile Institute in New York it is an educational center full-service laboratory and learning facility as well as a private practice location for a multi specialty practice for implant aesthetic dentistry. Currently he's lecturing for the continue education program at NYU CD for dental districts and US Europe Asia his patient base includes many celebrities, sports figures, fortune 500 companies, producers, directors and writers in the film industry, executives in the fashion world, world-renowned chefs and restaurant owners he maintains his private practice. I could go on and on he's got more initials after his last name than the alphabet. So with them what are you passionate about today wire what are you lecturing about at MegaGen's implant symposium?
Dean: Well first of all thank you for what you've done for dentistry I want to recognize that and most of you who are on know that you've changed the way people get information so I appreciate that. The biggest thing has happened in the last three years is digital technology which we've been a part of it about years so what we developed was a hands-on program for doctors to really get their offices their techniques really really honed in on digital technology using whatever scanner that they want I have five scanners on the premises at my new york smile institute because i realize it wasn't about the scanner it was about the information that's being transferred between the dentist's and a laboratory. So if people have a scanner I think the optimization of their use has really been limited because they were only learn how to do a single you'd or a couple units or maybe a bridge or now we've taken that digital technology and really expanded it to everything diagnosis abutment design restoration occlusion and really changing the way the dentist's is actually working in the operatory a lot less less a lot less stress free it's a stress-free environment now.
Howard: So scanners are you agnostic or do you like some brands more than others?
Dean: Like I said I have five scanners different scanners in my office so and you say to me patients coming in today and they want to get a tooth and I want to prep a tooth take a final impression with a scanner I'll pick the trio's I'll pick 3Shape I'll pick a Care Stream I can pick CEREC I can make my own crown with separate I could do a four do anything I want at any moment I'm depending on what I have. If you're gonna go with one scanner you want to go with the fastest scanner that's most integrated with your the most laboratories in the u.s. there's 3Shape I mean right now that's the fastest there's other ones coming up by the way.
Howard: Are you are you concerned with the 3Shape Invisalign and the align tech lawsuit?
Dean: No I'm not concerned with that because I know I know behind the scenes I know the people who running both companies it's just a marriage that's gonna happen it has to happen for us as the dentist provided for the patients. So if your practice is more of an Invisalign practice you may buy iTero if your practice is a restorative implant based practice you may buy Trios, at this moment in time in 2018 the scanning technology is so accurate it really doesn't matter five years ago it did matter but to me it's pick the one you like that you're gonna be using in your practice on a daily basis and then go with it. The critical decision is where is your laboratory where are you sending that file because if the laboratory is a little bit digital and they're buying twenty thousand dollar printers as opposed to a fully digital laboratory which buying a half a million dollar printer that's the difference.
Howard: Wow that's profound. So are you placing implants are mostly restoring?
Dean: My first implant that I place was 1992 so yes.
Howard: So you're placing implants and restoring...
Dean: Yeah but I couldn't tell people that we were placing for the first 20 years we have prosthodontic referral practice yeah so I couldn't but today it's game on.
Howard: So what do you what do you think your dentist's out there don't know about placing implants that they should know?
Dean: Well okay so if you're a novice starting to place implants you want to be with a company that is a digital technology company so it's not just that about the implant anymore it's the system that you're gonna purchase. This purchase of this type of like MegaGen, Biohorizons I mean you have great companies who have a system behind them it's not just the most expensive implant that doesn't make sense anymore, having the company that's a world-renowned that doesn't service the customer. I want to be serviced as a as a provider and what the company to call me I want to have a rep on the premises I wanna have people there backing me up right that's what you want from a digital from an implant company but that has to be 100% digitized and a lot of them aren't. So we kind of focused our doctors we have a big course at NYU a full mouth rehabilitation course and we lead them into the companies that are leaders in the profession of digital technology and also have great implants with great success.
Howard: Now you're a hundred percent Greek?
Dean: A hundred percent Greek.
Howard: Have you ever used Windex while placing the implant?
Dean: Well no.
Dean: but we do use peroxide this is another great little technique that we use.
Howard: You hear people talking that up to 20% of implants have peri-implantitis after five years
Howard: and some are saying 40% after a decade.
Dean: Okay we're at less than one percent.
Howard: Why is that?
Dean: because I understood the cementation process of an implant had to be perfect. I understood that the abutments had to be away from the platform, so if the implants here and you're prefab abutments right there and you miss a little bit of cement you're gonna have peri-implantitis. So when we started doing implant technology 2004 CAD/CAM abutments we made sure that our profile which one of the big things I talked about today and tomorrow at the symposium take the profile away from the implant and now your cement is here. If you're doing screw routine that's fine but remember the whole country with eighty percent cement roretain. Right so if they were messing up all of a sudden now you have peri-implantitis if it's not correctly analyzed and correctly designed your cement lines got to be away from your implant platform that's the key.
Howard: So when you look at the implant market a lot of lectures are they all on four theses big hero cases but when you go into the labs the majority of all crowns are done one at a time.
Dean: We're at 70% single units.
Howard: Yeah so on your single unit are you recommend cement or screw?
Dean: We're at eighty five percent cement retain we still do screw retain on certain cases our parameters for screw retained are short occlusal clearance so less than six millimeters you got to screw retain the case. The anterior implants that are placed lingually is going to be a screw retain case but we're pretty much guaranteeing our position is going to be good and we're gonna probably what 85 percent cement.
Howard: Cam one system for the general dentist can one system be all they need?
Dean: 100% percent.
Howard: and what system would that be?
Dean: I would say MegaGen right now where MegaGen is our number one implant in our .
Howard: and why is that?
Dean: Three main reasons one the platform is interchangeable with all the sizes that's a big time saver when you're talking about parts and pieces if you got five or six implants in a row and you got to keep changing the pieces that's you know for me it's slowing me down one driver one screw that was a big thing. The second thing we help develop their digital platform so they're scanned bodies are super easy and super fast. Third main reason hundred percent stability at time of placement you got eyes cube values at 70 to 60 to 72 when you place that implant even in the socket site so to me that's very valuable.
Howard: So are you immediate what percent are you immediately loading?
Dean: Interesting questions so if you ask me that in 95 to 2005 we were about 80% immediate you asked me today we're about 10% immediate, we've changed it. Why in our practice we're in Manhattan we're in a high very high crazy patient base we can't have a failure so I can't take that 5% chance so we're less than 1% because we're just being so careful we can't have a failure.
Howard: Why is it that whenever I meet someone who's placed over 5,000 implants they don't use a
Dean: Surgical guide
Howard: A surgical guide
Dean: You gotta have a surgical guide
Howard: but like I mean we were at this conference and you know a lot of 60-year old guys that placed ten twenty thousand implants and never... can't teach an old dog new tricks?
Dean: You're a special doctor you're a special person I think I really work hard yes I could do it without the surgical guy but when you're talking to dentists who are coming out of school and we are the leaders of them we can't tell them oh don't problem I never did it and I never use it don't worry you're gonna have are you gonna be okay you can't do that to the masses you gotta teach him and put him in the right train. I always tell my doctors get on the right train at least if you get on the right train you can kind of do it later right you can do it later you can get off the train and get back on. Start with a good concept of doing dentistry the right way I was taught with 14 prosthodontist that taught me just get on the right train do it right yes you can deviate from the protocol yes there's some cases you're not gonna have to surgically guide but if you're doing implant dentistry and you haven't done more than a hundred, you gotta do surgical guide and think about the patient behind the wheel the patient you're treating come on you can't do try things and see if it works you've got to kind of know. Today every patient is CT scanned yes I can place it without a CT camera I don't want to I don't want to have that error I can't have that error.
Howard: What Ct are you using?
Dean: We have the plan skin, Plan Mecca.
Howard: Plan Mecca out of Helsinki Finland.
Dean: Listen right now if you board a CT scan today they're extremely accurate so again I can't say once but
Howard: So you like to Plan Mecca?
Dean: Yeah because it integrates with our scanning technologies.
Howard: and you like the 3Shape which is out of Denmark.
Howard: So you you're a big fan of Scandinavia?
Dean: I'm a big fan of what works.
Howard: Yeah and Helsinki Finland I have a theory I've been to these companies Helsinki Finland for Plan Mecca and Denmark Copenhagen my theory is a sense it's completely frozen for ten months of the year they all tell you everything I'll tell you to your face to say your I said what do you do during those long dark winters, we worked in our there's nothing else to do because I went to Creighton for undergrad and it was so many times on a Friday night we had bad intentions and we wanted to go out drinking and great..
Dean: Beer you drink beer.
Howard: Yeah and you look out the window and it's like sleet and frozen and we just say you know let's just stay in and just study then the next day Saturday you had all these bad intentions of playing all day they're just frozen and then when I would did my MBA ASU and every day it was clear skies.
Dean: Well you know what it's time management my son just started NYU undergrad and it's time management you know if you have a team you have a sports team you have things to do I think you to manage your time differently
Howard: Yeah so what are you cementing with?
Dean: Cementation wow that's a big topic, so PFM's right now we're still cementing with Dunnellon Emacs crowns were cemented with relyx.
Howard: Wait PFM Durrellon,
Dean: Because it attaches to the Denton the Durrells is great when it's mixed correctly it attaches at the dentin. When we have a Emacs crown it's overly bonded because it's a hundred percent adhesive kind of crown. Now here's the trick and there's a lot of different opinions about zirconia, zirconia is not a real bondable restoration and the companies will tell you it is to me I found when I cut off a zirconia crown it just separates there's no bonding string. So it's still a metal zirconia is still a metal so I treat it as a metal now we teach our docs shoulder bevel like a pfm to have the closing angle and then you can cement with anything you want. When you submit with a resin cement on zirconia because the crown is not fitting exactly like a pfm or Emax crown it's a little bit dancing a little bit that that resin cement starts leaking over time so I looked at some my old zirconia crowns that I had flat shoulder bevels I mean she's flat show the preps I got leakage I was like I got to redo that crown because the the the margin just kind of opened up because the fit wasn't perfect because the cement wasn't really adhesive to the zirconia I wasn't getting a good bond strength and so now we changed our protocol to show the bevel now you can sub cement the zirconia without anything on but Emacs is reliable. How do you feel about that with zirconia crowns?
Howard: Well you know that the one thing I have on zirconia that I wonder is when you look at a hundred million insurance claims it just bounces long the four big spikes on the six year molars I mean what tooth is most likely to be crowned root canal extracted replace them by I mean if you have 32 teeth then the big spikes. Some of the endodontist wonder you know back in the day you bit down too hard the porcelain would chip off the metal.
Dean: Right the theirs also wear, there a little wear on the upper teeth too.
Howard: and so it makes you wonder is is this gonna be fracturing more teeth, is a zirconium with no give is that gonna be a long-term better deal?
Dean: We're about 20% zirconia we're about 80 like 60% 70% Emacs them or another 10-15 percent pfm. The zirconia ones that we use where I see the most benefit one is anterior teeth for the color change right but we still beveling long bevels or shoulder bevels because we got a ferrule effect especially on the non-vital teeth the nine-vital teeth are so fracturable they move a lot there's mobility you can get a shoulder bevel or a long bevel on it gonna have a better closing angle would zirconia so the color change is what I like to use not so much the strength. For posterior ya short teeth we recommend putting a groove into the preparation putting a bevel on the preparation so you got to get a little bit more kind of solidifying the the position of it and then you got to check occlusion, without checking occlusion to the nth degree of 9 microns you know you're not really sure where you're biting down so I think the bigger problem is occlusion.
Howard: Well that leads it to very interesting young occlusion is very instantly I know I've said this too many times but if I lined up a hundred endodontist they don't have that many controversies pediatric dentists besides silver diamondine fluoride they don't really have a lot of controversies but when these young kids are exposed to occlusion it's kind of like world religions. I mean you have you know are should they be Buddhist or Hindu or Catholic or Greek Orthodox I mean why do you agree that the kids in dental school get more confusing information about occlusion than any of the other specialties, do you agree with that?
Dean: Yes I do and I'll tell you what's going on, in the dental schools the occlusal understanding of occlusion it doesn't exist most dentists are kind of teaching what they were taught and they were taught by somebody who didn't know what they were taught. Why is Frank spear John quois panky man and Dawson so busy why is our program in occlusion book two years in advance because they're not being taught the right way. Now I have doctors that go to these wonderful occlusion courses and they come back to us and say oh this makes sense you've narrowed it down to explaining the functional position of these patients and we don't say we don't say CR is better than CO we don't talk about philosophy you know what we talk about this is the patient that you're training this is the situation that they're presenting how do you deal with that occlusion and going forward with single units or full-mouth case or an anterior case here's the patient analyze the patient. So we teach critical thinking and therefore we're out of a dogma persona we're in the you watched your dogma you're a CR okay let me show you CR in our situation your Co let me show you Co in our situation let me show you MIP in our situation let me show you in ethology which I was 12 with Frank Salinger, Howard Litvack, Vic delusion. I was taught in ethology we've taken it to a personal level specific for that patient and now the decision-making is very clear and we have doctors coming in from Spear great courses of Spear and Kois I mean those are my top guys great great clinicians right beautiful beautiful documentation and now we say them okay you got that philosophy let us show you your practical dentistry application for your specific patient to us and to me that's the best education because you're teaching them on Monday morning how to make a final decision and that's critical thinking that's what we're teaching.
Howard: Okay so she graduates from dental school her mom's a dentist her dad's a dentist she's in with her mom and dad now and every time anybody has a TMJ occlusion anything it's just the assistant comes in takes alginates sends the labs, makes an upper tray two weeks later an upper tray is delivered that's the real world for 90%.
Dean: and myself I do the same thing.
Howard: Well what are your thoughts on that?
Dean: Okay so there's two kinds of patients we categorize them as two kinds theirs the TMJ pain patient who's got some kind of formal joint position that's out of position post orthodontics 20 years right those are a lot of the pain patients they have beautiful teeth straight but they don't have no guidance you have patients that are just miofunctionaly in trouble. So that's a TMJ patient what we do with those patients by plate therapy for 50% of them 60% and get okay and the other 40% we send out to the TMJ specialists right so that's one category. The patients that come to us that I'm treating are no symptomatic, grind with their teeth they're all ground down their class one's ground down their class twos div twos in a position with those grinding or their class threes and their protruding but they're not in pain so that's a different type of patient. To the patients are in pain yes we'll treat them with the byplay therapy as much as we can and then they go off to the TMJ specialist so in our clinic and in our education we don't treat people that are in pain they get out of pain and then they can come back for restoration so most I would say 90% of our patients they have no pain even if they were worn down their teeth the dentition is really worn remember the teeth took the burden the joints are stable the tissue stable their teeth just got worn down so now we just got to restore the teeth.
Howard: Some occlusal cams need 10 or $15,000 machines to supplement the occlusion are you big fans of any of those?
Dean: No not at all.
Howard: So you don't need any T scans?
Dean: Oh IT scans are great hold on T scans great. What does T scan do. T scan gets us confirmation so watch this patient comes in and you can go on a website www.nysi.org you can go to our www.fmrnyc.com that's our course we have a lot of photographs FMRNYC.com and then you have fmrnyc.com that's a different one that's our course that's photos of class 1 class 2 class 3 cases. So going back to your question we take the patients where they are we analyze them put them in a decision tree and start treating those patients a certain way that makes it more personal for that patients and their jaw position and the way they are so that allows that the dentist to make a better understanding critical thinking of what they have to do for that patient, I don't that make sense but it just it's just more methodical the way we approach the patient.
Howard: These young dentists when you got out of dental school what year did you graduate
Dean: 89 dentists through 91 prost.
Howard: Okay 89 I was 87 that's why he looks so much damn better these next year's when we are done they're coming with a lot of student loan money.
Howard: So a lot of them always wonder what do I have to buy to be as good a dentist like you. I mean do I gotta buy...
Dean: I disagree I disagree they got it by education.
Howard: So do they do they need chairside milling?
Dean: Yes, well
Howard: or can they use a lab?
Dean: I would say if the first five years at seven years out of school you got a lot of loans to pay you gotta work this is my formula for my youngs docs we just did a course for Columbia NYU just like two weeks ago and I said these young fourth year dentist who are graduating for four hundred thousand five hundred thousand death I said what's your five-year plan forget about later on five-year plan you got six working days you got one day for your family you got six working days one day is for education period your Wednesday or your Fridays for education you got five days to make money go to a clinic go somewhere go to make a job go to get your money you got to three days to make money get another office that's a really high end office work there for a day even if you don't get paid a lot of money learn from that doctor have a mentor come to NYU have a mentor go wherever you are in your facility and have a mentor that's teaching you the business of Dentistry and the practical use of materials because out of dental school you don't know. So you got really four really work hard working days to make your loan payments to make your apartment image to take care of your you know needs but if you can stick on that plan and always have that one day of education you will be on the right path in five or six years when you can buy a practice you can join the associateship you can join a team but having that one day of education is going to keep your mind growing the education process in dental school just get you started it's necessary but that's the base now you got to grow you got to grow you got to grow so education is the number where you're gonna spend your money.
Howard: but go back you didn't answer the chair side the cad/cam...
Dean: Chair side the cad/cam.
Howard: You know because some things like we notice on dentaltown like you bonding agents well that's a very different length of time than if you're looking at whether or not to buy a CEREC machine or a CBCT.
Dean: but why would you go okay let's go through that route let's say I'm three years out I'm making some money working a couple things buying a CEREC machine is not gonna change my practice patient experience you know really it's not gonna really do that it's not gonna get me faster if I can make me more money really I got to get proficient in my dentistry so and I'll learn the digital technology in my learning courses all right and then when I'm ready to buy my practice or I'm ready to be a partner I'm ready to expand that's when you buy the CEREC that's when you buy the milling machine that's when you buy the scanners, so to me is you've got to get proficient in dentistry.
Howard: So an answer question they can be they don't need to buy 150 CAD CAM...
Dean: I don't think it's gonna make them more money right they need to make more money and learn and learn and learn
Howard: Same question about lasers a lot of people think they need to buy expensive lasers.
Dean: It's gonna help them be a better dentist but they got to learn the dentistry I tell my Doc's where are you at I'm saving eight years out okay you got some hear you got some experience on your pocket okay now that's next step you're in the seven-year mark it's time for the next step buy a practice associate by Machine but because you're at the next step. The first seven years you know that Howard they kind of just learn so I'm gonna do the dentistry just whatever it is learn it.
Howard: Yeah do you think you've been a Manhattan practicing for what, 30 years?
Deqan: I started in 1980 1990 I started my first office I had one patient.
Howard: So 28 years do you think it's do you think 28 years from now it'll still be market were private fee-for-service dentists will thrive or do you think DSOs and chain dentistry is coming into Manhattan?
Dean: I have a little bit of experience very little bit two or three years that I've been searching out the DSOs I think at first foremost which city or what state you're in, it's a very different stratosphere if you're in Manhattan and if you're in somewhere in Oklahoma City or somewhere you know maybe Idaho you know it's a very different very very different each city is so different. So I think if you look at the main cities the NFL cities let's say that see that is a really popular I think fee for service will always be there I think there's a market for the DSO companies to get the young dentists to work for them and they need help but they're providing a service they're providing financial help for these doctors but it really depends on where you are so the first question is where are you where you're practicing what's the demographic I'm sure you do demographics all the time where they are and then it's the best decision of which the best decision for me. Fee-for-service I think in Manhattan will always be there.
Howard: Do you think the implants extinct the Maryland bridge?
Dean: I think implant dentistry has extinct periodontal disease, we solved periodontal disease didn't we?
Dean: Yes we did
Howard: Treating it with extraction?
Dean: I'm sorry
Howard: What do you mean?
Dean: Yeah they take out the teeth you know nobody's treating perio, we still treat perio I was taught perio prost I still treat perio I save the teeth I save the teeth I save the teeth. Everybody's taking out teeth I think it's horrible I don't like that I see it all around the facebook and just taking out teeth putting five implants and calling it a day I don't think that's really a way to treat people because they're putting him in a box they're not really taking care of them so for me it's a you know you got to take care of the patient first.
Howard: Do you, are in this mindset that Emacs is only strong enough for anterior and you got to go zirconia in the back. I mean do you think molars really have to be zirconia or do you think you have emacs?
Dean: No again I'm from a different I'm on a different train my train is critical thinking what does the person have they have a grounded occlusion and they're wearing their teeth down and you're making one tooth in a really bad environment okay you're gonna use zirconia. You have a good system that's working there's only one tooth breaking she's 35 years old it's a beautiful tooth it's an anterior tooth to posterior tooth you're gonna do an Emacs it's gonna look better it's been beautiful it's gonna wear really well. So I think again it looking what you have instead of putting your patient into the zirconia box put the zirconia where it belongs put the Emacs where it belongs, for the anterior aesthetic veneers we use feldspathic we use feldspathic my teeth are feldspathic teeth and anterior all right they're perfect teeth they look gorgeous. So for me look at the situation and make the right decision for the patient. If you're in a clinical environment and yet the doctors not allowing you to make those decisions and everybody's in zirconia, listen you're gonna do what the doctors telling you and you have no choice but if you have a choice and if you're thinking smart you're gonna take care of your patients. Don't don't sell about don't sell a patient to the material make the material fit the right patient.
Howard: Nice, one of the biggest partial labs in the United States of America is I'm in Phoenix Arizona and you drive down to the Mexican border Nogales Arizona all the partials are sit there and they drive in New Mexico and there's a lab down there that makes about a thousand cast partials a day a day thousand a day and I Drive down there 90% of all the incoming partial impressions they didn't even cut us thing they just said lower partial not one...
Dean: No preparation.
Howard: Nothing 99 hundred a day is just it just here's an impression says lower parcel is that a little lame I mean?
Dean: No comment.
Howard: No I want you to comment I know you comment.
Dean: Listen I understand his financial burdens I get it but I think the education process again for a partial denture I mean I did partial lit review for NYU for four years. We went through hundreds and articles of how to design the partial to make it fit for the patient and it's not even the preparation that was so much necessary just the design just understanding how the design really works the fulcrums and the points. So yeah I get it look there's a minimal amount of time there's a minimum amount of money in a certain clinical scenario and they just don't have the time to do it I understand that I'm empathetic to that but there's got to be a consciousness for the doctor to say hey let me just think this for five seconds and say let me put a couple of rustes here change the profile and then take the impression it can't be that hard and if you're not sure of it then at least ask a mentor and say help you but removable. Look RPD is a big factor to help people they have no teeth they got to get something in there so it's big it's a big resource to help patients have teeth.
Howard: A lot of the young kids are getting conflicting information when is a quadrant tray okay, when do you need a semi adjustable articulator, when do you need a face bow?
Dean: The decision of that's a really it's a long question but I'll try to shorten it up if you have a posterior natural tooth and you want to take a triple tray I don't have an issue with that, if your posterior tooth is the last tooth in the quadrant and you're taking a final impression you gotta take a quadrant you gotta take a vertical bite because when they're mounting that case there's a dip there's a movement in that mounting if the tooth is there and you're chewing one or two teeth between the two teeth then you have at least a stable bite so it has to do with what teeth are in the neighborhood of quadrant dentistry. In terms of facebow's were again we're on the right side, again we say is any anything over six units has to have a facebow we use our Artex facebow from Jensen Artex. If I told you that it would I can teach you how to take an Artex facebow in 90 seconds would you do it on every veneer case, would you do it on every wax step would you do it on every full mouth rehabilitation, would you do it on every implant case for watch yeah but because it's taught in a way that it's cumbersome and it's 40 minutes or it's 30 minutes or it's an hour you can't take a facebow out nobody wants to do that but if I can do it in 90 seconds absolutely I'm gonna use it.
Howard: Some people say a post ads retention to the crown other people say the only function of a post is the fraction of the root, what do you do less post today than you did 30 years ago?
Dean: No I stopped doing cast posts because of the fracture potential you really can't figure out what your stress levels are and I had a lot of failures in the beginning of my career it doesn't mean they're bad and you have to do it the right way so technique is really really hard with cast post. So we believe in the flexi post system every tooth that's root canal gets a post I'd rather have a steel piece in that tooth then a hollow got aperture or some kind of you know material down in the canal so we put a post in every core and every week canal tooth.
Howard: When I got out of school 30 years ago they told me that dentures would go extinct and when I look at the macro data we did more dentures in 2015 than we do in 1985...
Dean: and I think that's because of patient awareness more than anything and availability I don't think it's because the denture wears no good I think they just they realize they can get teeth in a day or they can get teeth you know they can get it faster easier cheaper insurance is paying for it so you're gonna have an increase of denture prosthetics but not because there's more patients because it's more available. DOes that make sense?
Howard: Yeah so I want to switch from fixed Prost to a real prost two questions how many appointments can you get your denture down to you know there's people is sort of five and try to get to four to three and now we have digital dentures coming down the pathway and some of the digital denture people think that someday they're gonna get down to two appointments so are you are you I'm sure you...
Dean: I'm not a really good I'm not a qualified to answer that because I only do maybe one or two dentures a year so I'm not really qualified to tell you.
Howard: and why do you only do one or two a year?
Dean: It's just a population that we're in.
Howard: In Manhattan?
Dean: Yeah there's nobody who's got missing teeth the largest so we don't see that we see it more in the clinic at NYU but even there it's I would say five or year. So it's not I'm not really a good person to ask that I don't do a thousand dentures a year but I will tell you that the digital technology it still comes down to the impression did you get a good impression you know how to take an impression everything's gonna go a little faster when I do have a denture that I'm making it's five visits for us pretty much guaranteed five visits maybe six visits if it's a very high esthetic patient but I think dentures are here to stay they're gonna be very successful it's gonna be easier for the novice to do a denture at a high level that's what that's gonna happen, you have a novice doing a denture at a very high level and that's a good thing for the profession.
Howard: I see dentures around the country exploding also following the meth epidemic. Like you go to Southern Cal I go to California and you talk to all the dentist's there that are my age who practice her for five or ten years and like you almost never did a denture and then method bakersfield and then like every dentist was doing a denture a week we saw that in Phoenix where I can still remember I can still remember like in the early 90s and you know when I was in college I'd never heard it know that meth wasn't a thing back then and the bad boys smoked pot or did Jack Daniels.
Dean: or drank beer
Howard: and then I'll send out of nowhere you just had these people just losing it.
Dean: I don't see that and where we are but I'm sure I'm sure and why you would be a better caliber.
Howard: So it's really the the heavy meth areas. So amalgam I mean it's the most controversial thing, I just want to tell you my rant before. It seems like when I got out of school seemingly restorations last longer I mean they were amalgam, amalgams half mercury that's antibacterial the other half is silver zinc copper tends over silver diamine fluoride ten stan is fluoride I mean everything in an amalgam is not found in a multivitamin you know it's just you know and then we replaced it with these pretty tooth colored fillings and and all that when I get out of school all the guys that are my age from school said look I removed this amalgam and there was like black scuz underneath it how horrible now I'm bonding in clean composite I'm bonding all the woes I'm telling you when I remove a 35 year old amalgam there's like some black scuz underneath her like six and a half year old composites it's it's oatmeal I'm in there with the number four round bird taking out crap.
Dean: So that's that's I think it's an issue for the technique as good as we you think we are maybe we're not getting bond strength to the enamel maybe the enamel is not good. You know bonding realize on enamel if the enamel is not really good and we have no way to identify good enamel and bad enamel you're gonna get leakage you know so I can't do an amalgam because no one's gonna allow me to do that so I haven't done amalgam in 15 years but I'm really careful with isolation I'm really careful with analyzing trying to figure out is this and now we're gonna be good how is the occlusion again back to occlusion if you don't eat it'll last for 15-20 years so how do I change the occlusion to help my bonding. So I'm trying to do everything I can for to make those survive but we've definitely switched over to more of a scanning get an inlay get a Emacs inlay or Emacs on laid for a little better you know survival rate.
Howard: Do you think you think an mod inlay onlay milled porcelain would last longer than a direct composite?
Dean: I think so and also the new ones that are composite mills are really good materials so I'm seeing much more success with that I'd rather scan it and mill it even if we charge the same amount for the composite I know it's a two visit procedure but I think long-term I think it's a better restoration.
Howard: Are you doing any gold inlays, onlays?
Dean: I did oh I must have done over a thousand in my career I think .
Howard: All of mine are gold.
Dean: I haven't done it gold in about a year's or two I have a couple days that still want go it's it's still you know the standard of in terms of integrity and marginal integrity but I haven't you know people don't want it I just don't want it.
Howard: Yeah so what would you say podcasters are devoured by dental students i mean send me an email at email@example.com and tell me how old you are and all that stuff but about at least...
Dean: Can you give my email because I'm sure they're gonna have questions yeah firstname.lastname@example.org if you have any questions or want to look at the course or even if you want to come to NYU just for the day or you want to just fly into New York City and spend a day at our practice we open up our practice that I want you to know that to all our colleagues all our dental students or a lot of people around the world we open up our office if people can see and watch that's how I learned so I open my offices to people just as long as they schedule.
Howard: and the website is the fmrnyc.com yeah which sends for full mouth rehab New York City full mouth rehab New York City fmrnyc.com and his email there is email@example.com.
Dean: but personally firstname.lastname@example.org
Howard: drdean17@gmail and you gotta tell what's 17 ment.
Dean: When I was seventeen is when I went to the dentist I had broken teeth and he told me I had to spend $600 for two teeth I didn't have the money so I assisted him for about three years and got into dental school I was 17.
Howard: Nice that's very meaningful and on your if you go to FMR for full mouth rehab NYC com you have you have occlusion course, tell them what they're gonna find if they went to FMR NYC what are you gonna find on that website?
Dean: Well the best thing about that is to find a mentor find a collision course at NYU that we teach and getting doctors into a better level of education for themselves and provisionalization aesthetic dentistry doing doing veneers doing things the right way the techniques so it's a course that allows us to really teach you hands-on of how to do great dentistry and be a great dentist and get on the right train, you gotta get on the right train with the right mentors to be successful in dentistry it's a it's a tough profession and doing it right with education I think is the way to go.
Howard: Now are you the owner of FMRNYU?
Dean: We have 15 faculty members that we all part of that organization.
Howard: Wow and this is in Manhattan?
Dean: Yeah New York at NYU but the course is given at NYU .
Howard: are they one day, two day, talk about that.
Dean: There's four-day courses in October and in May it's four-day courses for people in the surrounding area we have a Friday course it's every Friday.
Howard: So it's a four-day course in October
Dean: or may
Howard: or may. That is so beautiful I got to tell you something. Yankee and Chicago every year every time we go to yankee or Chicago they always though they're always complaining about lowering attendance lowering attendance all that kind of stuff it's like dude it's your meeting in Boston is in February Greater New York I mean I mean the Greater New York meeting is the greatest meeting because it's the weekend after Thanksgiving.
Dean: Thanksgiving yeah
Howard: and there's nothing more fun than Manhattan in October November and December and then you go back to Chicago midwinter you say I mean when you get out of the cab and run for the door when you still get there you still like...
Dean: Your freezing
Howard: Your body hurts and you say to everyone there
Dean: Why are we here
Howard: Why in god's earth do you have this meeting in February or March.
Dean: Somebody started it.
Howard: We've had it this time of year ever since 1880
Dean: You got to change it ladies and gentlemen. I was just in Chicago before this meeting beautiful Chicagoans October beautiful it's gorgeous with 65 70 degrees.
Howard: Yeah I like going up there on St. Patty's Day where they turn the river green I mean Chicago.
Dean: I love Chicago, I love Boston but I'm not going I know it's between December and March.
Howard: I know so congratulations on having your course your four day course in October and May.
Dean: May, New York City in May
Howard: and try to lean on your dental meetings like you know sometimes a tradition is a good thing and sometimes it's been a bad idea for a century and I love Chicago as much as anyone on earth.
Dean: I wanna invite you for the May course and I want you to come and speak to the doctors about you know whatever you're doing in dentistry, I really want to invite you.
Howard: Well you know what you know what the I think the best marketing for your course would be is put an hour online CE course on dentaltown and we put up 40 one hour courses and gosh darn they I've had so many people
Dean: What if I told you I have an hour webinar that I can give you today and you can put it up on occlusion.
Howard: Oh my I would love it I give our CE so much credibility to have someone of your caliber.
Dean: 100% 100%
Howard: Yeah I would really love that.
Dean: A lot of our faculty our dentaltown I mean they always tell us what you guys are doing so if we they're all in with that we love education.
Howard: Well if you're under 30 year on dentaltown and Instagram I mean they just they do everything on their iPhone
Dean: Our Instagram is drdean007
Howard: and where'd that come from Dr. Dean?
Dean: I also live dangerously.
Howard: Well I seriously I would love to have and if you put up that course that the dentaltown magazine goes to 125,000 people so if you put an article and the online course that one-two punch.
Dean: I have an article to give you too.
Howard: My gosh thank you so much for all you've done for dentistry thank you so much for coming on the show thank you and talking to my homies.
Dean: Awesome thank you enjoyed it.