Dr. Crispin is one of the only dentists in the world that is both a Diplomat of the American Board of Prosthodontics and an Accredited Member of the American Academy of Cosmetic Dentistry. He has been an international educator for over 40 years and founded the UCLA Center for Esthetic Dentistry in the late 80s and Esthetic Professionals Dental Education Center in the late 90s. His focus in education is creating comprehensive hands on and clinical programs that are the highest quality and exceptional value.
VIDEO - DUwHF #1245 - Bruce Crispin
AUDIO - DUwHF #1245 - Bruce Crispin
Howard: it's just a huge honor for me today to be podcast interviewing Bruce J Crispin: DDS msaa ACD is one of the only dentists in the world that is both a diplomat of the American Board of prosthodontist and an accredited member of the American Academy of cosmetic dentistry he has been an international educator for over 40 years and founded the UCLA Center for aesthetic dentistry in the late 80s an aesthetic professional Dental Education Center in the 90s his focus and education is creating comprehensive hands-on and clinical programs of the highest quality and exceptional value in 1997 a university professor had a dream of creating a unique world-class dental facility this facility's focus would be clinical and hands-on training for Dentist and a rapidly changing dental market a quality communication oriented aesthetic laboratory was also developed to support clinical training and assists along I in their practices finally a consultation service was implemented to assist alumni and lab clients tackled demanding treatment plans or prosthesis designs while manufacturers support was necessary to provide state-of-the-art materials and technology no exclusive deals are granted to manufacturers this allowing course content to remain unbiased original expectations for development were achieved in the first few years and aesthetic professionals has become more and more than was ever envisioned over the last ten years of study professionals he's evolved from a thousand square foot facility with two employees into a 16,000 square foot facility with 30 employees and over 18 faculty members the Education Center has three hands-on training theaters and 20 dental operatories for clinical training a unique training center was also developed for the entire dental team to learn the many new computer driven technologies the laboratory of aesthetic professionals has skilled ceramists the finest technologies including microscopes at every bench and a great support team in addition the only finest materials are used and supervision is for I did III gotta tell you I graduate in 87 and the first guy that 10x to me was the man we're talking to right now I mean you have been a legend for 40 years which means you have to be what over 51 years old now I mean for me it was love at first sight lecture for you I was trying to get my fa GD in my ma GD and you'd hear all this conflicting stuff but you know they always say the sign of a genius is someone who can explain it to a sixth grader and you could actually go beyond that and explain it to me and which means you really had to know your materials where I am with so many questions I want to ask you so just a little housecleaning my homies a quarter of them are still in dental school and the rest are all under 30 I always say send me an email Howard at dental town calm and it usually comes from a dental kindergarten school so you're probably not talking to anyone 31 years old so I want you I'm and so they got out of school and if you look at the insurance if you could get a hundred million claims it's almost all done on for six year molars I mean what tooth most like they have em OD a crown a root canal an implant so she's out of school she's trying to learn her basics for three or four years and then get into her own practice so I'm gonna abuse you as good as I can and just go through the list what does she need to know about ceramic veneers
Bruce J Crispin: well that's a good question cuz we do you want me to tell you in about five minutes and let me just ask and one little thing to our business that maybe you didn't cover we also have a distribution center so we sell CAD cam equipment scanners printers all that kind of stuff so in our lab we also have all that technology and also in our school is that website study professionals com yeah it is it's called our distribution center so we sell about a CAD cam equipment and you know can't count materials and so forth so that's also part of our operation now my son actually started it said okay
Howard: I'm trying so I'm Darryl prints on a lab just reaffirm the highlight for it um the click thing oh ok distribution so you have education laboratory distribution and practice so distribution you're selling these materials so using them in Salem alright you pretty much oh well we like in you the stones so so so just stop go back there for a second so you basically have four so you have the education and it's hands-on over the shoulder is it also online we have some you know some webinar we're kind of just getting you know hands-on in clinical and so because my but my best marketing idea for you if you got a great hands-on course do a one-hour online CE course on dental town that's what pinkies been doing Dawson's been doing you know to try to give me at this kid to commit for a week they put like a one-hour summary of the week and it converts a lot to go so then laboratory so you have your own dental laboratory correct and it so Glidewell would be the Southwest Airlines akia Walmart use would be what the mercedes-benz Beamer Porsche
Bruce J Crispin: I think we're more of a boutique I wouldn't say we're really cater to super high-end Dennis we really can't cater what I call real dentists you know people that are out there that want to do dentistry wanted a good dentistry you want to learn how to do better dentistry and so you know right we're not just trying to focus on that prima donnas you know we're might and my goal really is not to cater to the top five or ten percent of the dentists my goal is to cater to the 95 percent well
Howard: what would be your unique selling proposition then when your lab is it more that they can get helper what distinguishes your lab from everyone else's well
Bruce J Crispin: first of all you know we use what we sell so everything that we do in our lab we also do in the practices and all the technology we sell so you know one of our sayings you know we use we sell and so we don't just sell stuff that's you know out there that's you know being marketed you know we use it we tried in the clinics we test marketed we feel comfortable with you a couple of our technicians can do adequate job with it you know before we're gonna turn it out there but I think you know most dentists and I think you were kind of getting to it with your age groups you know most dentist needs to handhold them you know they don't want a lab just tell them what to do to sell the latest thing they're to pay for their technology you know they really need somebody can get my honest answers about how to do things or when they're in the middle something and they forget or don't I bail themselves out or what cement to use or whatever the problem may be you know we're there for them they call us up and we help them out and I think that's really one of the big parts of our lab is really the support that we can give these young dentists in any dance really across the board when it comes to who we teach well you just
Howard: you just walked into a sliding glass door for my next question she graduated 284 thousand dollars in student loans so she so she starts wondering do I really need a hundred and forty thousand dollars CEREC machine to be a doctor like Bruce
Bruce J Crispin: well first of all I think Sarah is extremely over priced I was one of the first CEREC teachers when I was at UCLA and we still can't Kim equipment they will do twice as much for about $80,000 or less it's
Howard: nice nice nice so so she goes to your website under distribution you have CAD cam equipment on your distribution center yeah that's correct and so what brand what brand are you selling that's all that to bag of chips
Bruce J Crispin: I'd say the focus really has been rely on girl buck I mean what I'm an a Mongor buck it's kind of an Austrian conglomerate when it was materials one was technology and they kind of combined I had actually saw it several years ago and was impressed by it and you know when Chad came on board you know we kind of ended up in the same place you know it's just great equipment you know and it does a good but it's a lot cheaper it's you know like I said it's Eric yes and what Chad to me it does full mouth or is it does full art restoration bars it builds titanium implants everything I mean these mills are under 60 grand and the other thing
Howard: when I went to Sirona and in Austria I mean there were dentists there that were flying there to buy the Sirach machine there because they were avoiding the forty thousand dollar markup just from patterson at the time so so when the when these equipment people sign a what do you call it a distribution agreement where you can only sell through me I can't even get rid of a lot of competition I mean that that means a guaranteed profit margin right well
Bruce J Crispin: there are other distributors you know so we're just one of about three or four distributors in the country you know I mean our biggest there's our service biggest thing is your service and then you could teach them how to use the thing let me give you an example if you buy a CEREC what's really the biggest stumbling block or one of the biggest stumbling blocks for a practice you have somebody in your office they can run it and then you get turnover in that person and now so you don't have that person you know so having somebody there to do the design work you know is important and it means that you really want the dentist to do it then it should be in the chair you know doing dentistry things you know that they're licensed to do one of the things that we can do is with our equipment you can actually do the intro scan send us the scan we can design it and then transfer the information to your machine and you just mill it out so you don't have to do anything design work at all
Howard: Wow so science how about that that is very good you should be making a lot of online C courses on dental town day to get them over your way we we put up 400 courses and they've been viewed almost a million times and they're good they're good segues to where they get a see the instructor and I know anybody that watches you for an hour is gonna follow up with you I know me and you remember me and Mike do Tola sitting in the front row several times I I'm surprised you have layman what's that he was is he still he went to Sydney go to sorana yeah he was with glide world that he went to Sirona and I I forgot where he's at now but musical resonance yeah we're worried that they're lucky so so um before I start asking a bunch of questions on your education system I'm what why what are your top courses and why what why do you think you've gone from 1000 square feet to 16,000 square feet because right now she's driving to work and she's thinking my dental school taught me everything I had no more questions asked course she never did a single implant and VIS line so what are they calling you up for what do they not get in school for $400,000 that now they're coming to you for other than the bill you know I'm
Bruce J Crispin: I've been a dentist since 1972 I still take courses and I'm still learning every day and I think that's really what the practice of Dentistry is and dental school in my opinion gives you the license to practice and hopefully get you the point we're not dangerous but I think really it's a lifelong journey t learn really how to do dentistry you have to learn and you have to do it then you have to learn some more and you have to do it and that's why I think it's so important if you're going to an education center you know learn from dentists that actually do it you know the best teachers are the ones that actually do dentistry and I pride myself on doing a lot of Dentistry in fact I just tried in a full mouth reconstruction this morning and so I do it all the time and I think I make the mistakes and I try the new materials and techniques and it makes me a better teacher but our biggest courses are we have you know I take pride in the fact that we have the longest running as study continuum in the United States I started UCLA and I've done it here for the last 20 years so probably over 30 years and that really that course really provides the foundation for pretty much everything that you need to do restoratively even some implant stuff in a private practice and I think historically the dentist through it you know think they know a lot but when they get done with the program you know they realize they don't know a lot and they and they're motivated to learn more and I think that's really one of my missions isn't just a teach but also to motivate people to keep learning
Howard: ok well this show is called dentistry and sensor because I don't want to talk about anything that everybody agrees on I go right to the card controversies and I'm sure you're gonna really wish I didn't ask this question but it's all over the news I'm a dentist continue education it's all over the media we're a dentist a neuromuscular dentistry has been banned two Canadian provinces banned neuromuscular dentistry the Ontario Manitoba College for details the question - this is when she comes out of school she wants to learn more occlusion and my question is why is occlusion so complicated I mean you'd think complication would be molar endo getting out of broken rock why is occlusion I'm so complicated and when she's going through her journey she says eloquently in her emails to me at Howard it down time to come well it seems like I need to either pick between neuromuscular or CR panky Dawson and now the questions are like well didn't neuromuscular just get banned in Canada and yeah it's a it's on the news it was um k TV n dentist continue education linked to over treatment of unsuspecting patients dentist author of the banned book Confessions of a former cosmetic dentists say dental patients often add whole mouths over drilled by Dennis taught neuromuscular dentistry so just I threw like 40 things at yes so hopefully one of them was intelligent enough for you to answer
Bruce J Crispin: I think it's a very simple answer if you think conclusion is all that complicated you don't understand inclusion I think it's quite simple you know I the whole genesis of my crossnize education was it occlusion this is before aesthetics and you know before that stuff and they learned better do pantographs and try podding occlusion and all that stuff what I really learned over the years is you can make 95 maybe even more than 95% of your patients happy by not making it complicated you know it's as simple as giving people a bit stable centric occlusion anterior gates it's really just that simple now you do that people with deteriorating joints and you know psychological problems and I mean that's you know that 5% maybe but I think the people that trying to create a camp they want people to come to their camp to learn about you know whatever you know and I think even drew a muscular dentist if you look at the technologies pretty clever you know you get you get the TENS units to relax muscles you can you know they're electronic devices it's kind of like an electronic pantograph in a sense you can see motions and timing you know but is it really necessary to use that for every case I don't think so I have the technology and I find I rarely really use it because it's not necessary and I think neuromuscular got is bad name because my you know I think we went to LV I promoted it as a way to get a bunch of full mouth reconstruction and it led to the possibility of maybe over treatment and that's kind of where it's got a bad name but good ask yourself one thing hard you got neuromuscular dentistry you have Co dentistry basically you guys see our dentistry along centric all these different philosophies they're all still pretty much here you know if there was something really all that terrible about these philosophies don't you think they probably would have gone away and so I look at it a little bit differently and look at it if these are still around there are there are disciples of these techniques you know what is it that they know and what part of that technique can I add to my armamentarium to make me a better dentist because they all have something I think it can contribute to making you a better dentist but again occlusion isn't that complicated and we have an advanced text processing program where we teach people already full mouth reconstruction but I call the baby steps I don't I don't teach how to grind full arches or take Florida precedence I don't want to do that's two down hard I'm all my butt doesn't have any fiber stick you wet I can't sit that long you know so we teach people I call it the baby steps we teach them how to break it up into segments and I can teaches third year dental student how to do a full mouth reconstruction okay but you guys know how to do the baby steps it's only between a specialist prosthodontist and a general dentist I know how to organize I know how to organize things that make sense and I understand the process from beginning to end I know the journey okay and I think that once you learn that you want you learn how to work your clues with philosophy into that with a few exceptions it's not that complicated
Howard: okay here's another true or false she's driving to work right now she's thinking oh yeah Howard and Bruce two old guys who graduated in the golden years of dentistry when it was all high fee low volume and now she's walking out of school and it's all low fee high volume and she's saying Bruce it's 2019 is can I still have a high fee low volume practice or do I need to start learning how to do quadrant mo D composites an hour all day long
Bruce J Crispin: yeah I think with bills that students have for graduates having a dental scan what makes it really tough I mean I think there's a huge obstacle and I think that really has changed dentistry and that's why you're seeing a lot of what he call corporate dentistry when they go in and get a salary and say one medicine obviously but I think that you know if you're gonna be doing something for the rest of your life you know you got to kind of create the vision of what you want okay you you create a vision for what you want that makes you happy you know don't get it don't be defeated by the fact that maybe you have to do something you don't want for a while but if you don't have a if you don't have a vision of where you want if you don't have a destination you're never gonna get there now let me give you a good example I had a really good student of mine his name is Todd Snider he lectures a lot maybe you heard his name but he got out of school and he took all my programs he assisted me and I in a static two-year study program did at UCLA and he made the decision that I'm just not gonna go out and and fall into that trap I'm gonna I'm gonna have a vision of what I want I want a fee-for-service practice mcgrann you still have to take some insurance and maybe you got associate part-time or whatever but you got it you still have a vision and you know he struggled for a few years you've struggled for several years you know after he got through that and because he had the correct vision he eventually got to where he wanted to get and so what five or six years even if it takes that long or seven years on the rest of your life or do you want to just be mired down and the kind of practice you don't want for 30 or 40 years you know and I think the decision to me is pretty simple sometimes it's maybe just take the easy way out you know it's fun making money when you get out of dental school and you getting these practices and you're also making money but I see the same cycle over and over again you know you make money five or six years you're drilling and filling and seeing 20 30 patients a day the industry doesn't isn't fun anymore and to do that the rest of your life is pretty tough and my focus is at Rosie's dentists how they kind of break that cycle
Howard: Tom Schneider was on Episode four zero eight and it was a great show I'm back back to these um but back to doing more complex cases and I'm asking you questions again these are what I'm hearing from 13-under okay she's like okay so I got out of school and I went back to my hometown and I thought my dentist was amazing I'm working for him he doesn't even own an articulator and he says I don't need one how do you how do you answer and this dentist by the way might be her mom so I you know so try so tread carefully on this you're on black ice yeah they probably own an articulator but they use it for their boat anchor or something so what do you do with you when you graduate school you go into practice with your mom and she doesn't own an articulator and she says trust me you don't need one look at the good news
Bruce J Crispin: first of all dental school hasn't really taught that individual and why you want to use an articulator I mean they've got programs I take a face bone tree understand why they don't teach them simple techniques you know it's a program and articulator they don't and they probably never do more complicated cases maybe a denture or something you know but I think by today's standards if you're gonna do cases six or more you probably even sometimes less than that you know you really need an articulator and the beauty is you only won or ticket you don't need a bunch of articulated amore one articulator the lab needs that same articulator yet magnetic mouse and you just keep sending your magnetically mounted your models back and forth and so it isn't really that that expensive to get a good articulator we have little and what's the name brand in there articulator you said magnetic mounts all that kind of stuff well there's and there's a number of the two that we focus mostly on in our academic programs are the panda dent and the Arctic's the art x is sold by ama grbac that's the company does archaic em equipment I think is a carbon fiber the thing is really clever and then pana dance our local company here in California and they make great stuff too I've got about 200 articulator so you know that's the sign of a good process all right but I use primarily and we sold those to a good presence all right so I want to go back like say
Howard: I want to stay true to my homies and I'm gonna go right back because I I knew who they are that they send me 300 emails a day and so you know again they're working on for six year molars so when you know so it's gonna like when she wants to learn an implant I guarantee you go to the go to the CDA meeting or the ABA meeting they'll have a whole bunch of lectures on all in four and she's like dude I'm in Oklahoma dunno all on none and you know so so you know all everybody wants to talk about full mouth rehab and she's trying to do a crown on a six-year molar or her first veneer case or whatever so I'm going to go through and like say I'm here to abuse you on behalf of her a crown on a 6-year molar well what do you think things that she needs to think about
Bruce J Crispin: well first of all does need a crown I think crowns are really overdone you know and to cut if the tooth is really bad a shape it may need a crown but oftentimes it just needs to remove the restoration and do it online am I saying in preparation you just keep going to get to something good two-strike well or whatever and you stop and then you make an adhesive restoration just the beauty of contemporary restorative adhesive dentistry you know you don't have to be invasive but what's the beauty of that well this tooth invasion but it's easier if you don't have to go below the tissues you have to worry about bleeding you don't have to worry about Cardano problems you don't have to worry about impressions you know it's just easier and you know I like to say why make it difficult when it could be easy okay so two people she took out the LOD amalgam she took out all the decay and she's got what's left walk her through what would you do next remove the decay look at the integrity of the cusp you do occlusal reduction is necessary you may not even have to reduce both cuts a lot of times you can leave the non-functional cusp but the functional goes to a little you know fin but even still if you'd knock down both cusps you got inclusive clearance and you know you have a fair amount of thickness that your cuffs you know basically you just connect them you know the boxes with the cusp maybe a little champ or full chamfer and your business
Howard: so would you take an impression would you oral scan would you temporize would you chair side mill what would what would you recommend well I think it's also if you make any money got to be efficient
Bruce J Crispin: so I always make my snap my impression first so I give you trimming now the impressions in the mouth if you don't have a neutral scanner I haven't roll scanners so I'm gonna do both sometimes I'll take a traditional impression but a lot of times I'll take an intro scheme and then I just say the lab and they don't even have to make a model so so these the scanner some labs are saying that when their clients send in a scan they have one percent remakes when they send in a vinyl police lock saying or vinyl or poly ether it's a fight percent remake do you believe that or do you not believe that all right I think if the dentists the student is scanning and has good tissue retraction so you can see the margins I believe it is blow me up a compared to the old Sarah and some of the old digital technology it's unbelievable and
Howard: she always one of our biggest complaints on the show is that they won't name a brand like you said oral scanner and she's like come on dude is that are you talking about three shapes out of Denmark you got about three M's true death for you talking about in line technology owns I Tarot she might be getting into Invisalign so which oral scanner would you thank her to
Bruce J Crispin: keep in mind that I'm a dentist so I look for products that makes sense for me as a dentist so initially we got involved with Kodak for our indoor scanners then we went to cure the Carestream took them over and so Carestream we got our CT machines from them and now we use the care stream intro scanner I will say that we sell that so but I don't I didn't start selling it before I bought it I got it before I start selling ins that make sense and it's a fantastic technology and if you look at some of the research it's as good or better than just buying out there and it's certainly very competitive I think they're coming out with a brand doing this even better we just saw out this week early in the week the rep came by so that's the one I would recommend there are rugged scanners out there but I think a care stream makes them fantastic you know CT equipment and in scanners they're also getting into the CAD cam you know cheers I can't cam market and so you know so you can integrate everything and so I would certainly start there so about the CES the Carestream 3604 dental restoration in Charles scanner that's the one you're liking I'm sorry 3600 - this is 3100 mill it's powered by X okay you can share side software and the beauty of it is you can go from an internal scan to actually finish product of the mill and under 20 minutes completed to finish restoration you can go from what to what internal scan designed the crown then mill the crown in under 20 minutes so you're looking at 17 to 23 24 minutes depending on the side the restoration and the material you're using but you know we have videos online on our YouTube channel as their official YouTube channel also demonstrating all this one of our sales girls Holly is walking you through the entire process on the chair side software by exocad and it's just amazing
Howard: Wow that is amazing because that's the biggest beef against chair side milling is that the you know the patient was in the OP tarry for two or three hours and what do you think is again back to that six or most she comes in she's got a number of six or molar scans Mills how long do you think that appointment could be reasonably
Bruce J Crispin: I think what you have to do you have to learn how to you have to learn how to a point okay obviously anesthesia well usually anyways and you gotta you've gotta prep it and make an impression but you know to be sitting there waiting while this thing is milling you know you're up working on somebody else you know and so you know your staff is designing it if you got your own internal scan or I mean your own intro mills you may design it you could design it off-site as possible and so there's the milling and finishing and then you know it depends on where it's at in the mouth if it's in the aesthetic zone you still may have to do some ceramic staining that takes some time if it's in an honest that its own you can basically millet polish in cement it so that's where you know the six-year molar oftentimes there's a pretty speedy process and care stream is not care stream but I'm a Gerber has developed a different milling strategy for their for crowns and oddly it's just to make it faster and so it is pretty time to fish it but I think you still have to know how to schedule so you're not sitting there waiting your patient may be sitting there waiting a little bit but you're not sitting there waiting is the dentist you're using up your valuable chair thing and you were talking about impressions versus in Charles scans and you remember when you're doing an internal scan the software that Carestream utilizes their RCS imaging software you know you know what's the labs biggest complaint look I've got no room I can't see the margin etc etc when you get a traditional impression well the dentist goes and they do the preparation they do the scan well you've got that prep right this big we're sitting right in front of you yeah right you can see undercuts you can see and with the software it'll show you instantly if it's got an undercut what is my clearance for the opposing tooth do I have enough room with this prep it walks you through all of that even before you even send it to your mill or send it to your laboratory if you don't have a mill so you're not losing another chair another appointment but you know by getting them back in because you don't have rhythm or the preps wrong or something's going on compressions that I mean that really to your time and saving chair time that's where you're gonna actually make West your home I did one yesterday and I took the scan and now I can do a pretty good prep but I just didn't like I had a little bit of a rough spot on my facial margin Chinese my back prepped it did another quick scan took me about a minute and you know a lot of me to evaluate make sure it was the way I wanted it retaken impression all under probably been our cocoon
Howard: okay one of the one of the questions millenials always ask is is it an open or closed system so in regard to this care stream gentle if she buys that does it work is it an open format with other technologies or is it your in care stream and you're in a closed system yeah I wouldn't buy anything that's a closed system period okay some of them might not even know what we just said so it's explained what I just said and what your answer was and why in case you had to understand open or closed
Bruce J Crispin: for my generation I like to kind of equate it to stereo systems you know you can buy a serious system it's all one company Yamaha or something or you can go out pick your speakers from one company you pick your turntable for another company I pick your receiver or whatever kind of company what's the same way with technology you can you can get your mill from one company you can get your standard front of the company so you can kind of pick you know I guess whatever you feel is best for you or maybe it's the price maybe it's whatever whatever your your criteria are going to criteria are and then you can put them together anyway you want that's an open system I think one thing to remember when you're looking at Charles scanners is you know you got three shaped by Theriot care stream you know etc you know one of the big things they say okay well you can yeah you can you can export an STL native STL which will be incorporated in any other technology but you know what we're gonna charge to do that and on top of that it has to go up to my cloud and then get spit down back to your network and the problem is that just that just increases share time you know care stream came out early and fast as completely a hundred percent open software and the beauty of it goes right from the scam directly into your network directly onto your hard drive directly on your laptop whatever you're scanning - that's a truly open scanner right there's no thieves they don't charge anything and that's the beauty of it you know when you get into all these others they say yeah it's open but they're gonna charge you a monthly fee for that and that's just not open that's why I got my first carry stream scanner not all the hidden cause
Howard: well you know the there's the biggest in the minds of the closed system it would have been the the serac Sirona right right would you slowly start opening up - yeah but what it reminds me of is when I was little I got out of school in 87 and seamen's was the biggest company in Europe and their CEO decided they were over weighted in healthcare and had need to have more consumable so they spun off Sirona and the building was the same it didn't move and then Sirona eventually had to get married to someone then they bought x-ray oh they they murdered the x-ray it did so now it's des placer ona and now it is 30 years later and I'm seeing the same thing with Danaher Danaher is spinning off their dental division they're gonna that they it's gonna called Invista holding its NBS tea and i was wondering when a company like that spins off with Danaher spins off its hold dental do you think it'll get married with you think Lisa Ashby the CEO of care stream do you think she'll get married to that company or do you think all that those Danaher assets will end up at
Bruce J Crispin: I will tell you I had a lot of great relationships a lot of companies I've been to be right or not be broke yeah yeah I've been to that plan we made suits Sara because I when I was at UCLA we were we were kind of leading edge of leather their technology and you were the UCLA Center and I started using forsake dentistry in 80's it was the first one in the United States in a school in the Universities but anyway I've been to you know to cable in Germany and why these companies occur in every company in my opinion that I guess I maybe shouldn't tape this but I will anyway in my opinion every company that danaher's purchased has become totally a bottom-line company and they're almost impossible to deal with those are worried about the bottom line they really don't care about education and as far as I'm concerned you know Mama's relationship for the company this is a dinner ain't had I mean I bought you know 300 support three or four thousand dollars where the cable dental equipment they decide not to make it anymore in America and can't get parts trying to replace it all after ten years they should have less than 30 years and so Danaher in my opinion has really screwed up a lot of good companies and so I don't know maybe if they sell dental maybe it'll be resurrected by somebody I don't know but currently they're kind of on my naughty list
Howard: and that's really surprising because danaher's in Washington DC and why should you see never screws up anything I mean usually they're always fixing everything in that town of geniuses now I know be interesting but yeah until are you next time you talk to Lisa Ashby to tell her I'd love to get her on the show I got the same Mac hair stream too but I think I'd like to III think dentists like to hear from the people they're buying from so so I'm still gonna hold your feet to that fire she took out the m OD amalgam she took off everything until it's good sound too structured last you talked about oral scanning versus impression everybody wants it tooth colored what material would you go with him would you see met it would you glue it would you mill it chair aside would you send it to a lab
Bruce J Crispin: well maybe it depends what technology I have so if you've got a mill you're gonna use your mill if you don't have a mill you're gonna send it to the lab and I think the materials available right now I would believe towards the crystalline ceramics zirkonia like the new was a vita soprano t is a very clever material that just got clearance it's a little stronger I mean I think Emacs has been kind of a traditional buzzword when it comes to I delays and single units but I and it's a good material don't get me wrong I use it a lot but I think for you know those single units for something stronger especially analysts or ascetics I'm like a first molar you know the newer translucent zirconias are stronger than Emacs and I've done comparisons about a lecture where you know they're pretty much the same translucency as an Emacs onlay would be and there you know substantially stronger okay and we pretty much got through the cementation process so I don't think that's the issue anymore
Howard: you know I'm a cosmetic dentist which means whenever I enter the room I just dim the lights and I insulate but still would you seem edit or would you bonding if I do full-coverage zirconia it has a strength you know we got traditional circumference retention like a crown
Bruce J Crispin: I use a resume of a glass ionomer like a fluoride and you do get some bond because you don't really need it you don't need the adhesion to retain the restoration but when you start doing our delays or crowns maybe with lesser retention then you got to use it use of technology those are corny of crown I would use a resident modified glass owner I use Fuji sim2 from GC there's a lot of good ones out there but that's the one I've used for many many years Fuki make some great GC make some great sense if I'm if I'm doing Emacs then you pretty much have to do adhesion so something strong legs are Konya you know you can cement a crown and it pretty much everything else other than maybe gold too many people are doing those anymore but they're pretty much everything else if you look at the Emacs you got a body if you're looking at something in the same kind of strength or age is Emacs you're going to bond it transpose what would you bond it with you're gonna use dual clear resin I you know we recommend doing a selective edge so yes enamel self-etching bonding systems and then a dual key or resonant but what's your go-to system for bonding actually we have a few I like cosmetic stuff we use a lot of Danville in goes a little company they just got bought by zest you know hurt alot egos in ball with them and he's a pretty sharp guy and so I got involved with their materials are really good I like their binding system because it has you know pretty much everything that self-etch total legend dual key all in one binding system cell prelude views that a lot fishing our classes we have so many products here is where a school is started to say it but the cements like I said like do a link from Cosmo des degrees cement we use you know another company that you know they think is a little lesser-known on the west coast I call T the altar dent of the East is pulp then hope that makes a really clever materials embossed yeah so they've got their you know the bioactive liners and restore the materials and they make some good cements bioactive cements they make some very clever materials I like I think there's a huge you might have ever seen resin module clear resin cements are all similar so what walk
Howard: walk me yacht through this logic I mean seems like when I got out of school in 87 it was all amalgams P FM's and gold I have seven on laser all gold set with a zinc with what is it sink zinc phosphate cement and this looks like the amalgams it was all active ingredient and was half mercury you'll never find that in a multivitamin the other half was silver zinc copper little silver silver diamond fluoride look at 10 stannis floor I mean there's all active ingredients and they lasted forever and our best idea was to make them cosmetic and take out all the active ingredients and it looks like the silver filling that was lasting three decades is now replaced with an inert plastic tooth colored it's pretty it's so pretty but it probably doesn't lasted that true or false
Bruce J Crispin: I think that's false and I've seen composites last many years they keep getting better especially in direct ones but if you're looking at direct restorative materials obviously you have some technique sensitivity but if it was a dental school that the students retired I do composites you know in which we thought were really hard when we were just doing amalgams and then they were taught amalgams after the composites and they thought the mel guns were hard so you know it depends on what you're taught but to answer your question I think if you look at our mallet what do you look at it you'll get it a white tooth look at it a dark gray restoration and are those margins breaking down yeah but can you really see the breakdown necessarily when you look at a composite you got white and white and if you got a little leakage or deterioration of marvin you can see it you know but I think I quit doing amalgams probably 30 years ago not because I didn't think amalgams were necessarily a bad material I mean smaller melons are great it lasts forever I just didn't like the fact that I was getting no ability to strengthen the tears I think if you're using something that you can bond to the tooth my goal is to try to slow down the deterioration process and if you look at any I mean you've been around long enough you realize when volumes are there they begin Malcom's and being bigger amalgams then they became a gold on layers or crowns or maybe P FM's and that was just the cycle you know and I think that is Dennis now we can break this cycle and we can certainly slow it down you know with our adhesive products with our adhesive technology and materials and I've been teaching that for 30 years and that's what he is a prosthodontist it was kind of heresy to do bonded you know restorations back you know 30 35 years ago but that's not to taste me it was doable by you know any dentist and you know it's a win-win situation it's really easier and it's better for the patient okay a follow-up question on the amalgams had active ingredients
Howard: I mean you know whenever you're leeching mercury silver zinc copper 10 life is not going to be too pleased with you but you mentioned these glass on immers and pulp done were now we have composites that have ingredients some people say yeah those are active ingredients those will help prevent biological infection caries coming back other people say no it's all marketing do you think these composites with glass ionomer pulp dense stuff do you think these active ingredients are actually going to help prevent the bacterial infection of streptococcus mutans
Bruce J Crispin: I called contingency plans if I got a if I've got a fairly deep preparation you know let's say I have a deep axial wall you know am I just going to clear anomaly on that especially you know in their cervical area and where's it probably gonna leak I spray a leak in that cervical margin okay saying that I'm Lee I want it to last 10 15 years maybe longer okay so what's the probability that I'm gonna get a little leakage in that cervical margin where maybe there's no e mammal so my philosophy is I want a back-up plan and so what I'm gonna do and I don't put it on every restoration but if I've got deeper areas that are closer to the pulp I'm gonna lay a little slow rate releasing bioactive material over that deep area so if and when I do get a little micro leakage down the road it's gonna run into a little bit of a roadblock hopefully to slow it down and that's kind of philosophy I operate on I don't like to just teach always do this or always do that there's got to be a reason to do stuff and if using more materials or doing additional techniques you want to have a justifiable reason for doing it other than I always do that that's not the right answer
Howard: I'm gonna ask you a question then you're gonna you're probably gonna roll your eyes and say would where did this come from but these are actually emails question okay she just again she just did that one crown on one tooth now the patient thinks that it's causing TMJ how would you even get your head around that
Bruce J Crispin: well first of all you got to do a good you know good evaluation before you start patients to make sure they don't have any pre-existing conditions it's the first thing that will keep you out of trouble most of the time if somebody develops symptoms you know why are they developing symptoms that's a good question I mean you know that the normal dentist usually just to win their develop system and what do they do they grind it out of occlusion you know but I never grind a tooth out of occlusion unless it needs to be drowned out of occlusion you know you got to see is it really I had a clue if they are developing symptoms you know the problem is the other problem is a lot of dentists just the only adjust centric occlusion and they don't necessarily adjust lateral excursions and a lot of people don't have very good keen eye on your eyes and if you know if you put a crown in maybe it's good at centric occlusion but they don't have very good answer your guidance and all of a sudden they're going into working or balancing interference this again clusion one on one and they start picking up working and balancing interferences it's gonna change the chewing patters that patient and you could kick somebody over and to have a symptom because you never really know where they're at you know if they're on that border between being symptomatic and that being said de Matic if they don't have any symptoms you know before you do the crown but we also do a course in occlusion this kind of intro to occlusion staying out of trouble we have a really clever dentists coming up from Carlsbad names brandy light and his all approach he choose a lot of symptomatic patients he makes that thing called via the what's it called the anyway it's a media splint kind of thing but his whole approach to teaching symptoms is how to avoid symptoms when you're doing a stream which is a little different pros don't wait until you have symptoms you know after you do the dentistry you know try to keep the patient from having symptoms you know by following some certain principles and I think that you know we've developed some things like the helping hand which is a device is you can actually put on the front teeth with a patient actually can hold their mouth open and control it rather than putting a wedge in their mouth of which you can open and some others save the joints you know those are the types of things that can cause post-operative sensitivity TMJ symptoms possibly you know so you want to try to avoid that these are some of the things that we teach
Howard: by the way if you want to study the canine Rhys yours the best canine Rhys ever warthogs and walruses I mean if they're not sporting the biggest canines on earth and by the way the elephant's tusk is not a canine that is incisor I want to change subjects completely with you when you go around the world and and dental town has 250,000 members from all 200 countries 69 thousand are on the app so they're from everywhere but what you're hearing from Japan France London Australia is that insurance companies have pretty much made the the routine practice of cleaning exams x-rays and fillings basically you just barely break even and everybody that is gravitating towards the two procedures where the insurance doesn't set the fee and that's clear liners and implants like when we were doing this podcast from Tokyo and France and London the Japanese dentist for telling me the Japanese dental insurance pays me $100 for a molar endo and I'm in Tokyo where the ground is a million dollars u.s. a square meter we have to pull the tooth and do an implant I mean we're not you know we're not from Mars so if she wanted to get into clear aligners or implants let's just take implants what advice would you give her she says I want to get into this implant thing I want to place my first implant I went to UCLA I graduated 14 million dollars in debt I didn't get to place an implant what advice would you give her to today it's the first step of her implant journey
Bruce J Crispin: you know we did a lot of implant programs where they did you know things on bottles that'll teach other nuts and bolts to a certain degree and we did courses where they might place one implant and the average general dentists never really followed it up case till the now that comfort zone you know now we do a program with dr. Frawley was on your broadcast awhile back we do a four-day program where they actually do you know 8-10 implants they extract teeth they do some bone grafting you know so they really get a lot more experience doing it so that's so obviously I'm biased I have an education center and so you know education is really a key to I call it creating the comfort zone you don't know the comfort zone you're not gonna do it so you have to go someplace where you can get that comfort zone so people can watch a video and get a comfort zone some people need to go to 4 or 6 or 10 day program you know sue me out of the comfort zone so there's everything in between but education is a key and a focus here for our programs is you know hands-on in clinical you know we're one of the few places where you can actually go and get clinical experiences in most areas of Dentistry vendors you know in our mentorship programs and then we you know then we're available to help you after the courses you know worlds available to hold your hand and help you out so that's one area I think another area that I don't think it takes the place of good technique but certainly guided surgery has been and helpful okay we just of courses hoisin and they and we actually make their they're guys and I think that for someone that's afraid of getting into a nerve or a sinus or something when you've got a guide that keeps you out of those areas you know it does give you a little more confidence it doesn't take the place of good surgical techniques you still have to you know reasonably good surgical techniques but I think that's you know extremely helpful as well or as education experience you know how did you learn how to do dentistry you didn't go to dental school and all of a sudden you felt comfortable doing everything you do something and you learn something you do something and you learn something you learn something a little more advanced and you do something a little more of an I mean that's the process you know you make a few mistakes along the way and you learn not to do that anymore I mean I've done this a long time and I made a lot of mistakes and I think that's why I'm a pretty good teacher because I'm you know I made a lot of mistakes yeah but I've done a lot of things right there I went to dental school so long ago when
Howard: I went to dental school the Dead Sea was only sick that's how long ago it was um but um I think if you want to learn dental implants just don't do anything because I hear that robots are gonna be replaced placing implants I heard an implant was placed in China by a robot shouldn't she just sit back and wait for Patterson to sell the robot that places the implant
Bruce J Crispin: let's go back to your comment is insurance because i think why do you think cosmetic dentistry got so popular 27 years ago because it wasn't really covered by insurance and so it was coming like people that had a need or a want you know and so people want their teeth straight so there's these blinders kind of puts ortho in the hands of people veneers generally isn't if it's just for aesthetic reasons isn't covered by insurance and so that allows dentists to develop fee-for-service components of their practice and get out of that you know drill fill and send it off to insurance and not get paid we have we have another practice in our in our facility here where we do accept some insurance companies and our hygienists with charging more that we got paid for the cleaning so we say well this is stupid so we just said we just said forget that insurance you know so we're going back to more of a less insurance companies and more of a fee-for-service but the point is go back to what I'm saying you know you have to learn how to do things that you can add to your your armamentarium it's gonna make you better or different or special in your dental community and things that aren't necessarily just covered by insurance because a lot of people will buy good dentistry if they have a need and you got to be the one that's there to supply that name it to me it's just that simple is it an easy transition I'm gonna walk in and it's gonna happen immediately it's not gonna happen immediately it's the process takes time but you got to start somewhere okay
Howard: I'm telling you her fear you know you're either happy and pursuing happiness or you're fearful of anxiety so she gets out of school she goes back to practice with her dad her dad's telling her to learn implants and she's looking at all these implants that her old man's done in the last 5 10 20 years and she thinks a quarter of a third of them have gum disease around him so then she's saying you know the person that gets a dental implant that usually wasn't your yoga instructor addicted to tofu it was usually your smoking drinking Irish buddy and so patient selection I mean she's uh she's confused so what about all these implants all this Perry Plan Titus and and what do you do when you go into the room and he's sitting there with his bottle of Jameson he says ma'am my tooth fine I don't feel any pain I can eat a Big Mac and she's like my god the hamburger around there it's all inflamed it's all peri-implantitis so how do you address the growing revolution of implantology with the growing morbidity peri-implantitis
Bruce J Crispin: well I think first you got to realize that you know the whole arena of implant technology and diagnosis and grafting you know you know has really advanced the last 20-30 years and so I think that if you can get a good foundation by today's standards you are gonna have a pretty high level of success having said that I've been doing implants and restoring implants for many many years I bought UCLA their first implant system when I was head of the clinics there and I see these patients coming in with laptops a red showing and and lots of recession but you know interestingly if you can keep the disease moderately under control I think it lasts a long time you know it you can go in and smooth the threads or you know get them on water picks or whatever you know it's um just because you've got some you know some bone loss a tough and it's probably gonna happen and some of your patients over many many years you know it is fairly controllable I think you know and it is it to the point where you know they're so infected they got to be removed I don't see it that much I mean some do yes but you know I think the other thing you got to look at is implants the answer to all the solutions I tell the problem you know I my practice started way before we were doing predictable implants and I don't have problems I do a lot of you know if somebody has a missing tooth I don't automatically assume it's gotta have a bridge not the teeth of a pristine and they got a ditch Listeria I want to do an implant but if they got crowns adjacent to an indenture listeria Manning a bridge might be a better solution for some of these people so you know I don't need to be dogmatic I'm not a very dogmatic person so you know I think there's still you know a lot of solutions other than implants that will get the pearl yeah and and I I think if you're dogmatic you're not a doctor
Howard: I mean you know I mean you're just not if you have a one-size-fits-all I mean I mean like like I knew Dennis well I have a patient come in I'll have eight route service cavities he's Alzheimers she doesn't even know the name of his own child that's taking him to the appointment and they're trying to do these high aesthetic bombing things when my dad glass on him or amalgam anything would be better than just some you know a steady composite and he's like whoa I'm gonna cosmetic dentist it's like yeah well that guy in front of you doesn't even know he's alive so shouldn't you make something that would last two years instead of seven the last six months I'm gonna switch gears again completely went from crowns implants I want to go back to your dental laboratory you see a lot of incoming cases all day long what do you think you're there just seeing the case they're sending it they don't get to see all the incoming well what is the low-hanging fruit of all the incoming where if they were seeing all the incoming they would not be sending you this what what are you seeing that you think what are you seeing at a thousand fiha 30,000 feet looking down that she's not sending seeing sending up an impression
Bruce J Crispin: well I'm a little bit fortunate and that most of our lab clients are my former students and so you know they come here and they learn better techniques and they know that that I'm gonna take a look at things and I help them but but I think that I even business the things that probably create the most problems is going in there and doing something irreversible before you really thought out what you're doing you know they go in and from something without thinking about the rest of their mouths you know they prep maybe a man to your teeth or post your teeth but the but the case really needs a vertical dimension change and they're wanted to do foregrounds you know but it really needs ultimately a change in vertical dimension so you haven't really thought through the total treatment so anytime you start a treatment when things get a little more complex because the onesie too threesies in our in our lab or not a problem we get good impressions for the most part we send them back or not but you know pretty much we get we're getting pretty good work but when they when they start doing more complex cases you know that's where you really gotta know what destination you're heading for and you got a sequence you know we teach people how to do full mouth reconstruction zip you can do 60 at a time you can do a pull my fingers right any footmarks got with very few exceptions and so it's just a matter of knowing your destination and learning the baby steps and how to sequence it yeah so we provide that kind of information and
Howard: I'm you can't make this up his lab is in Tarzana California right Tarzana California you know it was named after Tarzan right there Tarzan had in the state here yeah so uh if Tarzan came into your office and needed a crown on number six since he's since he's so muscular just like me would he have to have a full gold crown would you could you do an empress what what what's the single unit crown you would do on Tarzan yeah I don't use goal is too expensive I used a zirconia zirconia yeah and you would see minute um so
Bruce J Crispin: yeah I would use a piece of technology if it's the full crown I would probably use a resume of a glass Hammond oh my gosh I can't believe we're already we've already gone past an hour what would uh one last question if you got time for some little overtime is that
Howard: you always talk on your website mentorship you got a section just on mentorship what does mentorship mean to you and why is it one of the sections on your website which is aesthetic professionals calm aesthetic by the way why is aesthetic so aesthetic est ATT I see that's what English and then if it's a es de aesthetic its French is that right aesthetic an aesthetic English they is were European he is more of an American at least to my knowledge you know so well you know my research found on it was that they started printing all the printing was by the cost like a lot of British words have an extra letter in them but due to printing the Americans think of everything faster easier lower-cost they would take out letters just to reduce the cost kind of like when we got our school member a classified ad it only liked dental assistant wanted and it was like 300 bucks yeah you couldn't you know you couldn't afford to say anything else like five years experience just like her had me one assistant there you know three so yeah so they took a lot of those letters out just for the cost of typesetting but what does mentorship mean to you and why is that a section on your website aesthetic professionals
Bruce J Crispin: we used to call them you know residency programs and you know we in education is you know tough so you know everybody thinks they're gonna get everything they need to learn online and you know they don't need to go out of program that's why we focus on your hands on a clinical but you know the feedback I was getting is that younger people I guess is the people that watch this program you know wanted people to mentor them he really wanted somebody they could contact and get information from and and not just a one-shot deal it would be an ongoing thing and so we changed it from residency the mentorship we modified them but you know we pride ourselves about mentorship for life when you took once you take one of our mentorship programs you know you're one of our alumni you know we will mentor you forever and so it's not just you come you go and that's it so mentorship to us means you know once you become a part of our alumni you know group of alumni that we're there for you to help you out in any way we can we are your mentors well Chad
Howard: I want you to wrap this up with what do you think she doesn't know about she already gets all of her supplies and equipment through her local dealer I say she's already using Benko what is what is what is she how were your supplies and equipment different and what should she know on your website about it aesthetic professionals calm as opposed to Patterson shine Benko
Bruce J Crispin: I mean easily the difference that products are the same I mean that's that's pretty simple but what sets us apart is that we actually have opened that container and used that clinically or in our laboratory we've touched the material we've touched the equipment we've touched the software and when you know another representative from another company Benko Patterson whoever it is walks into there you know they're reading cut sheets they're reading sales reports they're really you know very few technicians are sales that are salesmen for venko or Patterson you know they're great guys I know a lot of them you know but we actually are technicians and we actually use the equipment every single day we kick that thing around we kick the mill around we kick the scanners around we know what it can't do you know so we're not gonna oversell it we're gonna tell you exactly what materials that can do what technology can be used for what what material is best in every kind of indication or solution and you know because we actually use this stuff and that's the difference and you get direct lines to you know service a forty-year-old prosthodontist you've got you know a full direct line to all of our technicians you're not going through helpdesk versus customer support and hopefully you get to some guy who actually maybe have used it you get direct access to you either dentists or about technician for everything that we sell
Howard: I really view it with a marketing tip I love your YouTube channel I'm very impressed you have 7000 subscribers on your YouTube channel but the way to make your YouTube channel explode is if you go into dental town and you answer a question when you hit reply one of the buttons is YouTube so if you go to your YouTube video and when you hit share it'll say copy link or embed you click the embed drop that in the YouTube button and then on dental town when they hit it it goes right to your YouTube and then they have a very high conversion to subscribing so no answer three or four questions with your YouTube video and your views will explode again I want to end this thing saying that selfishly narcissistically for me just for Mainbrace you were so instrumental in my career and i got it same with Mike teutul I I don't know if you knew this but I probably saw you like 12 times I mean it was it like five times six times and some of your classes it was great because I was trying to get my ma Gd and you needed hands on and I remember one of the guys said well you this course it's the same course took three times in a row it was yours it's like I needed the hands-on and every time I retook your hands-on I learned more and more but you really 10x to me from 87 to 95 I mean I was hanging on your every word and all you kids out there when you got out of school in 87 you know I was in Kansas and everything modern was in Los Angeles UCLA and a leader of that whole cosmetic California UCLA bleaching bonding veneers was Bruce the man Crispin and you're always be a legend in my mind you you're definitely a legend in all the baby boomers so I hope you Millennials ask your mom or dad say what do you know about this Bruce Crispin guy and she'll let you know but Bruce thank you for all that you've done for me personally thank you for all that you've done for dentistry and it was just an honor to have you on the show today things
Bruce J Crispin: I appreciate the kind words.