Dentistry Uncensored with Howard Farran
Dentistry Uncensored with Howard Farran
How to perform dentistry faster, easier, higher in quality and lower in cost.
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1170 Robert Brenneise, VP of CAD/CAM : Dentistry Uncensored with Howard Farran

1170 Robert Brenneise, VP of CAD/CAM : Dentistry Uncensored with Howard Farran

4/8/2019 5:34:49 PM   |   Comments: 0   |   Views: 285
Recorded live at Townie Meeting 2019.

VIDEO - DUwHF #1170 - Robert Brenneise

AUDIO - DUwHF #1170 - Robert Brenneise

Experienced Executive Vice President Sales Marketing with a demonstrated history of working in the consumer goods industry. Skilled in Sales & Marketing Management, Market Planning, Customer Acquisition, Sales, Product Launch, and Medical Devices. Strong sales professional graduated from Woodbury University.

Howard: It is just an absolute honor to be sitting here with a friend of mine for three decades, Rob Bernneise.

Robert: How are you?

Howard: My gosh

Robert: It has been a while.

Howard: I know we are I think we had hair when we met that's how

Robert: That's how long ago that was.

Howard: and your daughter's the same age as my son.

Robert: That never worked out

Howard: but it never worked out we were trying to get him married the whole of the whole 30 years is she still a karate champion?

Robert: Yes

Howard: So Rob has been on the lab side of the equation I knew him probably 20-plus years at Denmat

Robert: Correct

Howard: and now and Bob Ibsen passed on.

Robert: Yes

Howard: and he was a we got to podcast him before he passed on...

Robert: Awesome

Howard: That was really great he was just a legend and so you went from one legend Bob Ibsen to the other legend Jim Glidewell.

Robert: Right

Howard: Both in Southern California so I feel like you know these dentists take a impregum impression and send it to the lab but if you've been practicing 30 years sending the impression I think they need to hear from the other end of the guy like you receiving the impression. So what with them so what's got you passionate now in dentistry after 30 years?

Robert: I mean to your point I've been fortunate to work with two legends for sure so I've always had great opportunities given to me and working for great companies and great products. Right now extremely passionate and joining Glidewell about they're in office million solution the

Howard: Okay so in office they also call it chair side milling.

Robert: Correct

Howard: So what's the official term is it in office milling or chair side?

Robert: No I think to the doctor in the industry it's chair side milling

Howard: Okay

Robert: Yeah the in-office is just kind of the branded name for Glidewell.

Howard: Oh that's right io, the and that's actually the website?

Robert: Yes correct

Howard: Yeah so if you and so whenever you see .com that's the generic one but what people have been doing is they've been taking the Internet country code so there's like 220 countries so IO is the islands of England or England.

Robert: Yeah I think when you're looking at up yesterday I wasn't even aware.

Howard: The British Isles dot IO because it's Glidewell dot in office.

Robert: Correct

Howard: Glidewell.IO and I like to explain it is because they're commuting to work they're not taking notes right so you put it in their head they're walnut brain they can go back to work and type in So what is

Robert: So yeah it is Glidewell's you know putting their foot in the door with an office milling solution which kind of seems counterintuitive for a laboratory let alone largest laboratory in the country if not the world right.

Howard: Well it is.

Robert: I get asked by dentists daily and even Industry of you know why are you doing that isn't that taken away from what you're doing and you know I think one of the things I've learned in my short time with Gladwell already is them wanting to be their own disrupter and I guess one of the best analogies always here is blockbuster Netflix you know blockbuster was market leader thousands of stores and new technologies were emerging and they just felt that they weren't a competition and all their customers wanted to come into their store you know and Netflix wasn't a competitor.

Howard: and Barnes and Noble was the last person to sell books on the Internet what were they thinking?

Robert: Right yeah so I think this is right in line with those concepts and Glidewell probably one of the only laboratories in the world that has the ability talent resource money and vision to build their own in office mill, the software is designed by Glidewell so it's you know just a way for them to continue to evolve with their customers and give their customers what they want and you want a mill in office great we're there to support you, you want to send to the lab obviously that's still an option to.

Howard: I would have back up a little bit. So the first chair side milling machine was CEREC.

Robert: Correct

Howard: Pretty much, the market leader then E4D out of Dallas popped up then they were swallowed up by plan mecha or yeah plan mecha out of Helsinki Finland but it seems like a lot of people it seems like it's more popular to do digital scanning than chair side milling so can you talk about digital scanning first before chair side milling?

Robert: Absolutely I think you're right that is more you know accepted right now and is become a norm a couple of years it's gonna explode even more so it's kind of the first step in the digital world.

Howard: When did you start seeing digital scans come in and what percent of the market share is and I'm just talking about the bread and butter six year molar individual single crown.

Robert: So I guess from my perspective and experience really started to see it well probably five six years ago it's been around longer obviously

Howard: That's brand new when you're old as us, it's less than ten percent of our life.

Robert: Yes sadly but yeah and then you know definitely the last two years it's picked up a head of steam and I think the next two to three or are you know to a tipping point for digital impressions.

Howard: So we're not really at a tipping point here, at what percent?

Robert: I'm gonna give you a hopefully an educated guess based on some of the things I've read it's twenty twenty-five percent of the market our users right now.

Howard: One in four, thats huge.

Robert: If I'm quoting accurate information but that's but from the labs the largest lab in the world side I still get emetic ated guess I think it's you know tenth of the cases coming in or digital the rest are still physical impressions.

Howard: Okay so one in four dentists has a scanning ability but only what percent?

Robert: I think it's about ten percent of the cases that come in.

Howard: So as a lab person would you rather I send you a I'm old-school my first impression was an 84 it was Impergum polyether and here I am right sex and I took one last week same thing would you rather I send you three MSB polyether Emperor gum in a quadrant tray or would you rather I send it a scan?

Robert: I think definitely the scan I think any lab would probably feel that way. The you know doesn't make you a better impression taker if you're taking bad impressions just because you have a scanner doesn't make you better you still have to do it right and take the time but definitely it's faster easier better from the lab perspective you know Glidewell you send in a scan you can get a case back in three days.

Howard: but explained why...

Robert: Well it's basically can get into production quicker and a Glidewell any physical you know all those physical impressions they're taking they digitized so they take all those physical impressions

Howard: So they don't pour them up with stone anymore?

Robert: Right they scan them and turn them into digital and get into the digital workflow.

Howard: So basically we're skipping that step?

Robert: Yep

Howard: That's why it makes it faster.

Robert: Yeah so faster

Howard: So their taking the Impergum and scanning it in a box it's already you already have the digital scan?

Robert: Right

Howard: and that saves you time and money?

Robert: Time and money and the data shows fewer remakes and less adjustments than physical impressions.

Howard: and how much less remakes and less adjustments? I mean I've heard some say that if you send in an impression is 5% remake if you send in a scan its 1% you think that's...

Robert: So yeah that's probably pretty close and you know how you translate that into what an eighty percent less if you're guessing that five to one and one to five so yeah it's definitely and I think any lab loves their doctors for that.

Howard: and think of the think of they money I mean you know trucking consolidated because when somebody when they built the interstate system in the 50s and I picked up a trailer load and I took it to you from Phoenix to where you're at?

Robert: NewPort beach

Howard: and where you a new board a ship and I drop a load I make money but if I have to drive back home with an empty trailer that's called deadheading and the reason there's no independent truckers left is because you need a national company to get rid of all the dead heading well when that patient comes back if it's 5% if it's one out of every 20 patients comes back in that chair and they're dead heading you're not billing anything out is you got a rien press that took all the profit dollars from that case are gone now and you might take all the profit dollars of another case to cover that deadhead and these dentists don't really know their accounting that the getting rid of if you could reduce your deadheads 80% in crown and bridge that's just you can walk away from that.

Robert: Absolutely because I think one of the things I've read is 48 percent of revenue in a GP's office is single-unit restorations and so to your point that second appointment to have to redo that not only are you lost all that on that case you've lost that chair for the new patient or the next patient that could have been sitting there so it's absolutely huge.

Howard: So I I don't want to ask you a politically incorrect question but this is dentistry uncensored so I'm gonna force you to make some enemies right now there's so many scanners on the market and you know she's driving to work and she's like come on dude you've been here 30 years make the decision easy, 3M makes a true definition scanner there's a three shape out of Copenhagen Denmark, there's maybe they have a Dentsply Sirona right now that they have a scanner, Align Technology on the Invisalign on the iTero scanner. So she's asked you point-blank I'm gonna hold your feet to the fire she wants to buy one what would you what would you tell her?

Robert: So it's a it's a great question and I have to go no I'm so you know Glidewell is a laboratory works with every scanner there is for short and loves to work with all those cases I guess that the answer I would give you in terms of the Glidewell IO the in-office million solution we have chosen to only integrate that with the iTarot.

Howard: So and Jim Glidewell if there's somebody smarter in dentistry he hasn't introduced himself yet exactly he said he's coming up on his 50-year anniversary, the guy the guy is 10x smarter than anybody else in the field I mean he just and you know that's true because he's Irish how else could you explain it but so that speaks volumes. So why do you think Jim Glidewell chose to line up with iTerot?

Robert: Well I think there's probably a few factors one the ability to work with them and fully integrate this digital workflow so it truly is seamless and the user experience is the best you can get if you're working within the office. I think the you know out of the millions of scans that Glidewell has probably received and the data they find between all the different scanners and and what it leads to in terms of that in office use with you know probably lowest remakes cleanest images all those things came into play and making that.

Howard: I want to tell you what a Jim's secret sauce recipes from mildness is something Jim's told me this is what I believe is that you know when you're trying to do make any decisions you got to have data-driven decisions and when Jim started Glidewell 50 years ago he didn't buy some off-the-shelf software programmer he hired his own programmer and I was always so amazed where you'd call him up and I'm always talking to you about you don't know your phone's you don't realize that 39 percent of your phones get rolled over after three rings to voicemail or not answered or not picked up but the whole thirty years you call Jim Glidewell they would the incoming number they'd already know it was Today's Dental, they already know your whole history that that operator knew everything about my relationship was Glidewell from day one. So when Jim makes a move it's not a gut feeling like I got a gut feeling it's all data-driven with Jim, so he's just data, data, data, so obviously he was seeing something better with itarot scans then all the other scans or he would not have made that decision right Jim making a bad decision for some superfluous reason or something.

Robert: Yeah I mean point well-taken and I think you're right I think technology has always been a vision of Mr. Glidewell's and ahead of the curve and has always used that to their advantage which is ultimately the advantage for the customer.

Howard: So your chair side Glidewell IO an office chair side milling in office milling if you're gonna do that you need to have the itarot scanner?

Robert: Correct

Howard: How much does my tarot scanner costs how much does the chair side milling cost is there a package deal on it?

Robert: Yeah so if you look at iTarot their element to I was 33,000 retail, the Glidewell fast mil and design software is 50,000 retail so 83 retail but packaged is about 75 76 thousand as a bundle so there's a you know a package.

Howard: and I doubt none of my homies right a check for that they probably all installment credit?

Robert: Right, yeah

Howard: Is it lease to own?

Robert: No it's purchase so but most are financed absolutely.

Howard: and what is the average financed?

Robert: What we see is five to seven years so being financed.

Howard: Five years 16 months to 72 months and then what would that monthly be at sixty months what would it be?

Robert: So it's about for the whole system about $1,400 a month if you're financing for 60.

Howard: Okay 1400 a month so that would be okay so 14 single crowns would probably would make that 14 crowns at a hundred bucks would be your 1400 a month payment.

Robert: Yeah good point so yeah we usually at our price point can show yeah somewhere 15 to 20 units that you might be sending to your lab if you mill those in office now you can basically implement that system without increasing your expenses instead of sending to your lab you're sending to yourself or your equipment and anything over that you're immediately seeing a return.

Howard: Okay now explain to her why she says chairside mill she's scanning it anyway, say she uses iTero anyways she's got an iTero and a lot of people have iTero it's an extremely popular scanner because of all the people doing clear aligners with Invisalign and it's funny how when your orthodontist get really mad at Invisalign for some business thing they're doing with smiles drug club or opening their own stores whatever I say well then are you gonna quit using as line they go no yeah so the praise it's kind of like you might be mad at the owner of mercedes-benz but you're not gonna trade your mercedes in for it .

Robert: I remember that in our early days with Rembrandt right Rembrandt whitening toothpaste and you know had a consumer products and dentists were upset because there was a Rembrandt whitening at the time it did you know it just drove the overall market.

Howard: Back to Bob Ibsen, people just don't realize how many genius things he did, he actually when he launched that he was the sponsor of the Miss Universe?

Robert: Yeah Miss America I think it was Miss America.

Howard: and Miss America that's a good one but Miss Universe is fixed because the winners always from Earth no one's ever won from another solar system so it's totally a rigged system. So let's just say she's already got the iTero because she's doing clear aligners and so she can already send you an iTero scan and then you'll give what discount do you give if I send in an iTero scan for a single unit like sure molar?

Robert: So $20 off the unit and you'd save seven dollars in shipping so 27 dollars ultimately.

Howard: So for a bruxzir crown, what would it cost if I sent in a polyvinyl what would it cost if I sent in and iTero scan?

Robert: So 99 dollars if you sent in the depression 79 if you sent in a scan.

Howard: So that starts to pay for itself. So let's say she already has iTero, she already does Invisalign why should she not save $27 and yes why should she not save $27 and send in the scan to you and you make the Bruxier versus she in office chair side milling next her?

Robert: So great question I think it really depends on the office so if you look at being able to do in office or single visit crowns one that I did mention is the system's the only system that can mill fully sintered zirconia in the Glidewell mill so there is no oven time so you're not becoming a lab tech during the process, so that's one of the reasons bringing in the system. So you have patients who maybe are asking same-day dentistry one visit right they're becoming more educated some patients are asking maybe dentist around your market in your market are offering the same solution so you need to be competitive. We have many customers who bring it in just to reduce their lab bill hasn't even really adopted the same day part they just mill their crowns at a you know sixty seventy percent lower price and have their patients go home in temporaries for a couple days but it just gives you all those choices so sometimes you do have the emergency the patient has to have it today.

Howard: You're the only one milling...

Robert: Centered zirconia so it's hard every other mill has to mill it in a soft state and then after you know 10, 15 minutes your team member has to come take it out of the mill basically get it ready put it in an oven fire it for another 15 20 minutes and during that process they're touching it two or three times and becoming a lab tech which is counter inproductive to the whole reasoning of having an in-office solution so with Glidewell's Bruxier are now you it's fully centered comes out of the mill just polish it up and place it. So while its milling your staying productive.

Howard: Okay I got these two female dentists who are identical to birth okay they're only separated by an operatory right so they both seat the patient numb prep they do the whole thing they both take a iTero scan send it to you the other one at that point it takes it makes a temporary and so she's gonna make a temporary and then release the patient then they're gonna come back dead head for a segmentation later. How much time would it take chair one two chair side mill the crown and cement versus the person over here making a temporary?

Robert: So we believe the digital workflow you do a single unit crown in about our 35 minutes from start to finish.

Howard: For an average crown?

Robert: Yep with a temporary, no with milling it in office forgive me.

Howard: An hour an hour and a half?

Robert: Yeah

Howard: Total time, okay and then what do you think it would be for making it temporary?

Robert: So just because we always ask the doctors to so we're using their numbers you know or their time based on what they do and I think it's normally it's an hour and a half to two hours is an answer they'll give us you know we'll ask them what's appointment 1 and they'll tell us an hour what's appointment two and depending on the office they'll say 30 minutes or an hour, so you know depending on your office it could be the the one appointment can be in the same amount of time as you do to two appointments but you're not temporizing you're not anesthetizing the second time, not flip in a chair which has cost to it or it can save you time for those offices that tell us it takes two hours.

Howard: Even or less so you're saying that you could in what in 90 minutes seat the patient prep the crown mill it out chair side zirconium seat done hour and a half and then the other person that person would be an hour and then they'd have to come back later for another 30 minutes to an hour.

Robert: Right

Howard: So it's about the same.

Robert: Yeah and again that's just we always use whatever the doctor tells us.

Howard: Yeah so what about a system where you had to have an oven how long do you think that's taking, CERAC?

Robert: So you know I'm gonna say it's probably taking longer and even if we take best-case-scenario and say time their time is equal between the two during that time with the other system your staff isn't being productive in the office right because they have to handle the material during the process. So I think you know even if all things being equal this is more beneficial because your staff continues to be productive in the office and not having to be the lab tech during that process. If we're saving 15, 30 minutes comparatively then it's it's a huge advantage.

Howard: You know I don't know if you know this about your first employer Bob Ibsen but he actually wrote the first book on cosmetic dentistry and it was called adhesive dentistry because you have to remember you have to get a technological revolution in order to have a market revolution there all these markets like take all the franchise's the United States like McDonald's well you would have McDonald's if Eisenhower wouldn't have laid out the interstates before the interstates most Americans never went their whole life without going 100 miles away from home and Bob Ibsen started that cosmetic revolution with adhesive dentistry so my question to you is all my restorations are full gold I would never do anything every full gold it's just there's there's nothing that compares to it but I know the market wants white tooth colored restorations and I always call that the aesthetic health compromise. A gold filling lasts longer than a composite filling I don't think anybody on planet earth doubts that I don't think Jim would doubt that I'm sure he has a lot of data for that but if you're but the market all wants tooth colored yep I'm sure your daughter once tooth colored what would you cement that tooth colored Bruxier restoration with?

Robert: So they just recommend a resin glass resin-modified glass ionomer is the kind of the material of choice.

Howard: Any brand names?

Robert: No I mean none specific you know usually it at the educational courses the doctors will ask and it's you know whatever they're cementing their zirconia now that is fine.

Howard: Tell Jim what I would love to have more than anything with all with half a century of data how long he thinks a on just on a 6 year molar well and will keep everything constant with the same tooth you know like number 3 how long does he think of full gold crown last versus a porcelain fused the metal which was most of our life

Robert: Right absolutely.

Howard: Now it's zirconia, what do you think those numbers would be?

Robert: That's a great question I mean they do you know the only thing I could share now is you know there's 18 million Bruxier now has been cemented Dr. Christensen and Rella Christensen have probably more studies on zirconia than anybody and you know how it affects the adjacent teeth and so I will ask mr. Gladwell I'm sure he'd be happy to have someone pull that info.

Howard: He's got so much data entry from 50 years ago.

Robert: Oh yeah.

Howard: and that's why he became the largest lab in the world and the only thing close to that size would be modern dental at his Chin Gen but China has a billion 300 million people United States has 300 million do I've always wondered about that too what percent of goggles business is United States versus the rest of the world?

Robert: It's predominantly US I don't know the percentage for you but it's predominantly US and they now have facilities and you know some parts of the other parts of the country or the world, I should say, in Europe, Latin America you know there's Glidewell facilities there for the local market there.

Howard: You have one facility outside United States oh you have one facility in Costa Rica?

Robert: Yeah Costa Rica also.

Howard: Is that your only non US?

Robert: Oh no so Europe goes through your Frankfurt

Howard: Germany

Robert: Yeah

Howard: When did you start a Frankfurt lab?

Robert: I'm taking a somewhat of an educated guess so don't hold me to it but I want to say it's just five or six years.

Howard: Okay so new.

Robert: Yeah

Howard: and Costa Rica probably 10 years right?

Robert: Probably you might know better than me.

Howard: I was drinking down there.

Robert: You thought you saw it.

Howard: I thought I saw it, well Costa Rica is really exploding with Canadians and Americans these you go down there and they one of their big macroeconomic goals to drive their economy is to get retired Americans because if you take your let's just say you get a thousand dollars a month Social Security check well you can live twice as high on the hog in Costa Rica's you guys especially where you are in Newport beach.

Robert: Ain't that the truth.

Howard: I mean my gosh that's probably Newport Beach would be here Kansas would be here Costa Rica be here I mean these seniors you go down there they say my god I can eat out every night at the fanciest Mexican restaurant for three or four bucks I mean it's and what would that cost in Newport Beach?

Robert: Ten times that

Howard: Yeah so is Invisaligns down there.

Robert: Yes

Howard: So you got Glidewell, Invisalign, any other Costa Rica, any other players in dentistry?

Robert: Yeah there's a couple well the Viax dental is a lab down there and there's a couple more.

Howard: Well Utah they call that silicon slopes and up by Provo where Gordon is I mean how I gosh you got fifteen dental companies I mean you got Dentrixs and CRA and Ultradent and you have you know Curve and all these dental so we should do a cover story on Costa Rica.

Robert: I'll go with you if you need.

Howard: Well yeah we should go and shout out to Craig Seiken my buddy from Albuquerque he loves to go deep-sea fishing down there and me and Craig I've always gone deep-sea fishing in Cabo like three or four times so I want to go deep-sea fishing down there again, it's really good deep-sea fishing. So now that you have the Align technology with your chair side milling this seems like the next obvious thing you would start doing as is clear aligners is that something on the horizon or are you gonna because we've noticed the patents expired on all this so we've seen around the world 25 companies pop up making  clear aligners would you agree with that?

Robert: Yeah it seems their coming fast for sure.

Howard: All these people are getting into the clear aligners, so is do you think Glidewell will stay crown and bridge or do you think they'll start becoming an ortho lab too?

Robert: Yeah no I think a crown and bridge and implants and educate you know I mean kind of everything they're doing now and obviously now with the in-office solution is a whole another market that's open up to them so yeah I don't think so.

Howard: So let's talk about so your new things chair side milling Glidewell.IO in office but it seems like in the last five or ten years you've made a huge move into implants yes I mean in some of the legends out of Ohio they have.

Robert: Hahn implants.

Howard: Talk about how did how did you line up with Jack and how's the implants going?

Robert: So the implants are going fantastic and there's a heavy education platform behind that. How that started unfortunately I can't speak to you know I wasn't part of Glidewell when all that was developed and how that came about so but I just know it's a it's a huge part of what they do and what their future is and the educational platform to drive the education get the dentist comfortable with what they can do and want to do in terms of implants and then obviously you have the Hahn implants.

Howar: You talk about internal disruption that you know you're gonna be disrupted by a chair sight milling machine you guys want to own that know about technology well if anything was gonna disrupt the three unit bridge it would be the implant.

Robert: Absolutely

Howard: So did Jim start seeing a reduction of three you know bridges and say well we need to get into what's the new three-year bridge it's a single union plant and have you seen I mean have you seen a massive reduction in three unit bridges replacing the six-year molar as going towards single implant?

Robert: Yeah so I would think they definitely did and I think I've seen info you know some about 95% of the restorations coming in our single unit only 5% or so or multi unit I think it's exactly what you said it's the implants are replacing the three unit bridge and as we all know the implant market has been exploding for years.

Howard: Yeah and a major player of that the person selling the most implants is Strauman because of mergers and acquisitions I mean they bought me Odette in Brazil about Mis and Israel and I love the publicly traded company she's gonna see their drive and I've always told Dennis to do that I mean do you realize if you just buy one share of a stock on the New York Stock Exchange by law they have to send you their 10-q quarterly reports their 10k annual report and I just I mean to read Warren Buffett's annual Berkshire Hathaway report I mean that's that's like a one day a year to get your whole macroeconomic fix on what's going on and everything but I've found the data they were long story short when I read Strauman data was surprisingly the most that America first personally and a man on the moon per 10,000 Americans we place less implants like half as much as Korea or Germany. I think we're not even in the top 20, why do you think Americans what why do you why do you think we're not in the top 20 in placing implants per million people, why is there still so much partials bridges?

Robert: That's a great question but I you know I just going back to my years in dentistry I think a big part is just dentists changing behavior is a big change and in my career I got to go through it with Dr. Ibsen and lumineers back in the day where you know for a decade talking minimal or no prep veneers just did not gain any attraction or adoption and the minute we took it to the consumer for Lumineers and the consumer came in asking then the dentist one to at least understand it so they could you know either speak to it around it or offer it and that behavior change is just I think a challenge no matter what it is implants might fall into that.

Howard: I love Bob and anything about Bob is when Bob believed prepliss luminaires nobody could change mine because he was just his mind worked at a different level and what I used to see all the rebuttals came from frumpy old fat bald dentist I don't like the reduction it might look fake well first of all veneers look sake and what about that woman doesn't look fit I mean the red lipstick the eye shadow the wig the augmentations that they Botox I mean how could you look at any woman in America all made up and say that looks natural and when you ask that woman do it your teeth shaved down she'd say no and the dentist said well I'm gonna shave them down because if I don't don't look fake well they already look fake but she doesn't want her tooth shaved down and it was just so is prep list veneers what percent of veneers upper ten on a woman do you think our prepless vs they're still shaving off?

Robert: You know I believe the majority are still shaving and traditionally prepping for sure you know and back to changing the behavior and perception you know while it might not be for every case I definitely think even the fact if you know back then it got patients to inquire about it and maybe they weren't a candidate for minimal or no prep but now they were engaged and asking you the doctor and I think ultimately help more people do more cases no matter what.

Howard: Well I think the industry got cleaned up a lot just because thirty years ago all the cosmetic dentists just immediately prepped all the teeth for a pfm that was just that was crazy going to start to go to veneers there's still a lot of reduction but then when the cosmetic dentists start adopting ortho and now Invisalign so now that you got all these cosmetic dentists who at least have the skillset to unravel some Invisalign team if you just he just went three to six months in invisalign to do so much prepping so I think he's got really really conservative by dropping from where he had to cement a pfm when I got out - then you could eventually bond on a veneer but then unravelling it with ortho you know so it's getting better but I mean you look and the other thing about beauty a I want to tell you that when they do studies on beauty it's so funny that the number one variable is the site state of the mind like it's a girl sad people will rate her maybe a six or seven but if she was really happy she'll bump up to eight or nine or a ten so it's all how she feels is the most important. So when you're talking about natural well she looks like a clown to me I mean she's got bleached hair fake eyelashes lipstick Botox you know it's not the Botox the lips it's how she feels about herself and she just feels good about herself she's rocking it she owns it. I remember Marilyn Monroe when someone said oh that outfit you look like looks like you're wearing a gunny sack so what was her next model shoot in a gunny sack and she rocked it everybody's like wow that woman looks hot in a gunny sack. So it showed you that it's not the gunnysack when you look at those mob does runway shows they all look like clown out throw yes have you ever seen someone walked down in a runway that you later would see that outfit at the Mexican restaurant I've never seen it it's all ridiculous but it's how it makes the human feel and if you if you own and here's another thing you should do with your wardrobe hang up everything with the hook facing the wall and then when you wear it and wash it put it back have the hook face you and then at the end of the year look at all the hangers facing the wall

Robert: I've done that

Howard: Oh you've done that yeah in a year do the same thing your shoes point all your shoes to the wall and then when you put them back away in your closet after January first point them to you then ask yourself in an entire year I never wore that short of those for our shoes you know what the reason is it's not fashion just you don't feel good in that you. You always saw something that made you feel better to wear so just get rid of all that and saving ammo because every time I've ever spoke to a 90 year old dentist a 92 year old dentist I say which tooth lasts the longest they say the one the dentist never touched because when you touch that tooth to do it when you when you touch that tooth and do an MOD filling 10 20 years later that's gonna be a crown 10 20 years later that's gonna be a root canal in the crown 10 20 years later that's gonna be extraction to implant a crown and it all started because of the first time you touched a tooth with the filling. So touching a tooth condemns it to a life of retreatment so a true minimally invasive dentist like like Bob Ibsen was a true minimally invasive dentist is your hygiene department teaching kids how to not get cavities change their diet brush floss fluoride treatments so they never have a cavity so they never get a filling which turns into a crown than a root canal than a implant and especially now that people are living longer I mean we just had an American we just had that we just had Guiness registered the oldest woman in the world does it today and the first thing I did is I took that year and I times it times 24 hours and she lived she's right at 1 million hours now.

Robert: Wow

Howard: So now we have the potential of a human being born could live a million hours so think about that when you're shaving off enamel to do veneers this person could live a million hours are they really gonna live 900,000 hours after those veneers and the teeth are like yeah we got this we're good we're good for another 900 thousand hours it's a long time really long time do you think you'll hit a million hours?

Robert: I don't know how old is she?

Howard: 117

Robert: Oh wow that might be pushing it.

Howard: You know my luck the beer would run out first and I would have to spend the last 12 years sober. So we talked about the chair side milling you know what else are you passionate about what's got you excited?

Robert: Oh, I think the whole digital workflow is really where my passion and excitement is and focuses and where it's you know I mean 3d printing right next or coming or here all the above I suppose and what that's going to be able to do for dentists in office what materials will eventually be available and so we even see that as part of the evolving ecosystem of the Glidewell IO as a 3d printer will be next that just allows you to do some additional things.

Howard: So milling is reduction, chairside milling you start with a cube and you reduce it and it would save a lot of material to just print it. Printing right now is it all bleeding edge theoretical or do you see something that's done from bleeding edge to leading edge is something here now or?

Robert: I think in terms of what they're doing in office now you know printing models surgical guides mouth guards you know could you know we always get asked you know can you can you print a zirconia crown you know I don't think that's here today can it be I wouldn't know Mr. Glidewell and the team behind Glidewell probably would have a good idea but you know it just right now they can print longer span temporaries would be a great use for in-office that you can't necessarily do say in office mill.

Howard: So are you selling the the printer equipment chairside printing for temporaries?

Robert: Not yet that's on our roadmap so that I will probably within this year or next year.

Howard: and what material would it be printing?

Robert: That's a good question don't know that I think that part of figuring out what we want it to do what the customer wants it to do more importantly and being able to print it.

Howard: You know what I want it to print...

Robert: What?

Howard: You know what I want to it to print a gold onlay, because one of the reasons you can't print the reason you can't mill a gold crown is just thinking what percent of that block is millind away and waste when you make an onlay what would you guess?

Robert: I would say 80, 90%.

Howard: 80, 90% so there goes gold but it printed gold and then where would that lead to could you imagine taking a scan you extracted tooth and instead of placing an implant where you have to make the hole fit your implant just to scan the socket can you imagine scraping out renting a sock is scanning it and then milling out a titanium implant that just you wouldn't even have to just tap it right to place I mean that would be amazing instead of having it's I mean I like on the Hahn implant I mean how many sizes are there. So you have all you have all these sizes trying to fit the average missing tooth and then it could just go custom I scan the socket milled out or you can even take the extracted tooth and they came out in one piece and scan it the way you do is an impression and could you imagine that extracted tooth put it in there and even in for like a root tip of a broke off or whatever it wouldn't even matter on that own thing so you think you think that some Star Wars stuff or do you think that's five years down the line ten years?

Robert: It's probably both right cuz Star Wars what used to be Star Wars stuff is we're seeing while we're old enough to see it now the things that have come you know come to fruition so yeah I think it's yeah it's at its infancy and what it can do and you know both in its ability and the materials that can be developed for printing is I'm sure not even in our thought process.

Howard: You know my only claim to fame in dentistry...

Robert: What's that?

Howard: I'm the only dentist who owns a lightsaber and if you don't believe me asked my five grandchildren they'll tell you as Taylor grandpa's owns a lightsaber I actually do and she believes anyway.

Robert: That's all that matters.

Howard: That's all that matters, so you got any children yet?

Robert: I do not you just the son and daughter.

Howard: Son and daughter but no grandchildren yet. So what else are you know are you passion about?

Robwert: In the industry?

Howard: Yeah

Robert: I mean I just Wow so I think if I go back to you know I still have a passion for the conservative dentistry you know which is where I grew up in the Denmat world for my first 20 years of my career so you know and you were you touched on it a little bit about you know prepping for veneers and I still think that's just minimally invasive dentistry is a key and a must.

Howard: I want to tell you something else maybe this is too personal too much information I got to share it but these two legends you work for Bob Ibson Jim Glidewell you know what's the most interesting about well Jim Glidewell, I mean Bob Ibsen passed on but they had no exit strategy they loved with the reason you're asking why are they successful they loved what they did. Bob had hundreds of millions of dollars cash and what did he do he still did dentistry when I pod casts him about a year before he passed away here here's this multi-millionaire 80 year old man I said Bob what'd he do because well I created this dental office out for women is battered shelters and a lot of them their lover knocked their front teeth out so I'm doing what he loved the most cosmetic cases on the front and most dentists if I took their financial statement and traded it with Bob Ibsen's and they would have burned down their office and gone to Hawaii and that never touched a patient again and here's Jim Glidewell I don't know how old he is but he's got to be 70 right and he still hasn't I mean he hasn't sold Glidewell I mean he could sell it in a minute on a head you'd take it public he could have and what's Jim Glidewell exit strategy to exit his way from home to drive to work.

Robert: Absolutely and you're right I'm still talking you know 10, 15, 20 years down the road.

Howard:yes so you've been in this game for three decades and when I've seen you so many Dentmat conventions and our Glidewell conventions you've met so many dentists over your life so let's so give a dad talk she just graduated from dental school she's 25 years old and she just came out what advice would you give her 30 years of seeing some dentists that are more happy fulfilled successful and don't want to exit strategy and love what they do versus the ones who didn't make money got burned out he that wanted to get out what with lifelong lessons of success have you seen that you could share with her at 25.

Robert: So I think definitely the you know adopting technology and what's new continually learning being willing to change, they still talked to so many dentists even about a month ago at a convention had a dentist come up who looking at actually at a scanner the iTero and as to why but you know I've been considering been looking at these for I don't know post five or eight years and still looking well you know it's what he could have accomplished in those five to eight years even with the technology that was available back then just getting started would have probably made that practice better for it his patients happier for it so yeah it's just a continual learning and taking action and doing what you love if you know if it's veneers straightening teeth implants whatever it is find it become an expert at it.

Howard: So I think when the first thing he said which better not a whoosh over your head it's taking learning contained in your education the one thing I saw clear as a bell is that the dentistry took a hundred hours of CE a year which means they got their FAGD and  AGD in five years another five years at their MAGD all of those MAGD guys were happy successful profitable love what they do back to the technology is anybody knows you know when I put my babies in the bathtub if it was just water and we're here for cleaning they all want it out but if I threw in boats and toys and balls and stuff they'd stay there till you know their feet are all white and so we call I call them our family had all boys boys and their toys. So if all your toys are bass boats and duck blinds and Harley Davidsons and all that stuff well then you don't want to be a work you want to be at home so what I the other thing I saw is you know if you're a dentist and you rent a thousand square foot and it's kind of blah and there's no toys in there but in your home is 3,000 square foot and you got all these toys in there you naturally want to not be at work and you want to be at home. So what I think was the you know I think your office should match your house I mean why does your office not have a break room if you're feeling bad how come you don't even have a couch to go sit down on why do you live in this miserable dental office with no toys so I think when the dental office gets more bigger and more comfortable and like a brick I've always had a break room that offered all the snacks and beverages and all it's like cuz when you go home in your kitchen it's not a vending machine I mean you know if you want a snack you want to snack you want a beverage and toys. So if you're like I'm not sure if I want to chair side milling machine but then I said well what are you wondering about well I'm thinking about getting a new $90,000 bass boat I say well chair side milling machine is I mean I you know if you're not sure I mean I'd rather have a chair side milling machine than a bass boat you know maybe maybe in an iTero scanner is a better idea you know so we have so toys duo who taught me that lesson was Gordon Christian because he's a DDS he's a dentist he got his his MS he's a prosthodontist he has a PhD in psychology and one of the earliest columns I wrote he smacked me upside the head on it was called lasers does it stand for a light amplification stimulation emission of radiation or losing all savings equals reality and he read that cuz I've had a monthly column since 1994 he read that column and he called me how would he say hey he goes that guy is doing a repetitive task over and over and over from 25 to 35 45 50 but they burn out because I'm a psychologist he goes if they buy that laser and it makes him run 20 red lights on the way to work cuz they can't wait to get that work with that to play with their little toy he said if you can just keep them a smile on their face and not burn out they return on investment on that will be a hundred fold. So on dental town on facebook groups how many threads are there are I'm burned out well then do something new. You know you do endo get a 25,000 dollar global microscope out of st. Louis and drop it down there and before you do your operation look at it an 8x and you'll find out you miss the canal one of the canals that slop there or if you know if you drive a Mercedes Benz get the Zeiss they're twice as much maybe twice as nice I don't know but keep redo your office you know III think of all the things I've done to improve staff morale every time we've closed down for a week and repainted, reupholstered the chairs or got new dental chair just did it nicely because McDonald's is the leader and they whenever they open up a store seven years to the date they re got it and do it only so when you walk into any McDonald's around the world it's anywhere from brand new to seven years old and then you might go into some of these Denny's there's Denny's out in Southern California that Evan are the original IHOP so look like the day they were built and you said you walk in and like this is an old run-down Denny's and it's all right down because they they thought well I'm not gonna fix it up or do anything new so so keep it fresh keep it fun.

Robert: You may have a great point so listening to you I just made me think even you talk about running red lights to get to the office break rooms, Glidewell break rooms have pool tables ping pong tables massage chairs popcorn machines you know and I think I just really never clicked till kind of you said the same thing it's people wanted to be there and yeah you need a break or you don't feel good you want to sit down I mean yeah that makes a huge difference.

 Howard: Yeah just if your house is 10x nice if you want to be your house ten times more in your office something's wrong I mean something I a man like sometimes they want to skip out early like well I want to hurry him get home why oh there's this game on whoa you're at a dental office why why can't you go sit in a chair and watch the game so that you can do your last hygiene check because your hygienist says well I'm gonna have an exam at 5:00 you're like well my four o'clock cancelled I'm gonna forget the exam I'm going home but why but actually why are you going home maybe I'm you're hungry well don't you have a refrigerator in your in your office why is there this big urge to get the heck out of your cage and there's a great TED talk on it's called the rat cage and when they did the rat cage I so for half a century one of the pending studies of why drugs were so bad is because when they would put rats in a cage and they did it with monkeys to and primates and they'd offer from a water bottle or a bottle with drugs in it like you know various different drugs they would always choose the drug and the rats would take though the water laced with cocaine until they are actually dead and everyone said look at this drugs are so bad because they'd rather drink cocaine laced water than water until they die and it's at fifty years for some guy to come along and say dude they're in a cage do repeat the study from a rat cage to around Park so he redid the study where they had other rats to play with and windmill they had everything a rat loved in a rat Park and guess what the rat never drank the cocaine water and just drank the water and now it's a tipping point Portugal was the first country to start reevaluating their whole drug policies are like okay guys under a bridge should he heroin do you think there's maybe a chance he's living in a rat cage and is putting him in a gel cage how is that a solution. So they start saying well let's go get this guy a haircut and get him some housing and get him some food and find out what's wrong so they took the same resources of locking him up and said well this is about what we spend on a guy on drugs or alcohol or whatever let's put that money in trying to make his rat cage light more like a rat park and the substance abuse they have the lowest substance abuse of the known world whereas you know in a substance alcohol is the 80% of it but like in the United States it's like you know like 14 18 %, Portugal's 5% when they start doing that. So that I the first thing I thought is how many dental offices are so cool and the first guy that really beat this in my head was one of my classmates Brian Neuwirth he opened up a dental office he was the first guy he was the smartest guy I know and I walked into his operatory and it was like it was like the size of a front room every operatory was 10x10. I said why is your operatory so big why is there a couch and all this here's what I figured I was gonna spend a third of my life of this room so if I'm gonna spend a third of my life in this room why is it eight by ten and when someone comes in and you're trying to find a chair that they can squeeze in the corner to be with their their family member why not just have a damn couch why not a lazy boy why not why not a refrigerator and he built these I think you know everybody was 10 by 12 I think his were all 25 by 25 and guess who still loves dentistry today more than anybody I you know I mean it's just still loves it because day one he built a rat Park and then what's the what and then if you build a rat park what's all your homies saying oh he built that Taj Mahal I say okay who said that okay I said that okay you live in a Taj Mahal no one's making fun of you living in a Taj Mahal and you hate dentistry and you post all your postings are you're burned out you hate dentistry and then you called the happy guys who lives in Taj Mahal in fact I would say this if you can't afford a nice dental office and kids why don't you why don't you rent in an apartment and put your money in an investment a dental office and make someone to hang out that before because what do we do when we drive through poor areas of town like in Phoenix when people say well he said living in a run-down house it has a $30,000 hot rod in the front yard, well you think that's a misallocation of resources I would tell that guy that he should have gone to DeVry Institute and got a better job or a better education. So you know that that I'm in poverty areas you don't want to put $30,000 in their car if you're if you're unemployed living in a worse part of town. So yeah so I think rat Park is very important.

Robert: Absolutely agree.

Howard: So I can't believe it's been an hour the final question, she's 25 any other trends of advice who in the 30 years cuz how many dentists have you talked at the booths at the conventions I mean...

Robert: Thousands and thousands

Howard: Thousands and thousands, so what trends we talked about continued education we talked about working in a rat park instead of a rat cage any other technology so all your boy-toy shouldn't be boats and shotguns it should be a scanner or something any other things?

Robert: Well the CBCT scanning is seems to be pretty you know up-and-coming and a lot of excitement and passion from dentist and I actually probably don't talk to as many about it just because where we are they're talking about you know say Glidewell or Glidewell IO in this case but you know reading a lot of post articles there seems to be a lot of interest there.

Howard: Post articles?

Robert: Post and articles I mean just seeing in the industry publications but it's a little out of my realm but that's probably one of the other hot tiles.

Howard: Final words when this podcast goes live I want you play this last minute to Jim when you see him what the reason I loved and respect Jim the most is because I grew up with seven kids in Wichita Kansas the whole family trees Parsons Kansas Nevada Missouri you know lower-class hillbilly redneck area and I would go to these Institute's and they always talked about wanting to work on A patient's and you didn't want to work on B you sturdy when they describe the a patient other bankers millionaires lawyers and then the B patient's kind of about and then really get to the CD and F patient they just described my entire family tree and I would always think well those people need dentistry too and then I watch two guys come out one was it airlines Herb Kelleher Southwest Airlines and one was Jim Glidweell and they both said keep one eye on the cost one eye on the customer use your brain to drive down cost until your customer has the freedom to afford to fly or save their tooth and then IRA got all these dental conventions and all these elitist cosmetic dentists from all their Institute's would the the joke would be Jim or you could use Glidewell am i what did that even mean and then they start calling to me. I remember in Dickerson you know every time he lectured at a seedy meeting she says you know we're Neiman Marcus we're Nordstrom's unless you want to be like Farran and be Walmart I'm like well what the hell's wrong with Walmart don't most Americans go to Walmart and if you try to make something if you're really really smart you can drive down costs the only secret to lower prices lower cost and it's innovation where Southwest wasn't gonna do the hub-and-spoke they're gonna fly direct and they notice when you made it airline ticket you only said how much is the cost you didn't say are you gonna be serving chicken or lasagna. You know so all he did it said this is what they're concerned about and Herb Kelleher drove down costs in flying cuz when I started lecturing in 1990 only unless your fortune 500 company was buying the airline ticket or the government only that class flew the American people couldn't afford to fly when I started lecturing in 1990 it was too expensive now anybody can fly and it was Herb Kelleher that made any grandma in America be able to afford to fly to her granddaughter's baptism her first confirmation or whatever and Jim did the same thing how many of those common people in the flyover States did Jim make them have the freedom to afford to save their tooth by driving down costs.

Robert: I think you said it perfectly as I've heard him say so that was spot on.

Howard: It was an honor to podcast you.

Robert: It was a pleasure.

Howard: Tell your daughter I still have them only two of my sons are married off so she still has two.

Robert: Still a chance.

Howard: There's still a chance.

Robert: Allright will do.

Howard: Thanks have a great day.

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