Dr. Sundeep Rawal is a private practice prosthodontist at Florida Prosthodontics, PA in the central Florida area. He graduated from the University of Florida College of Dentistry, USA in 2006 and completed his training in Prosthodontics at the University of California San Francisco in 2009 where he was exposed to the most current technologies shaping dentistry. He has worked extensively to utilize CAD/CAM technologies within the scope of clinical dentistry and enhance his patients’ restorative treatments. He has lectured across the USA as well as internationally with over 500+ engagements over the years, and published Numerous papers in Various dental journals and other Publications. Dr. Sundeep Rawal is a past president of the Brevard County Dental Society, and of the Florida Prosthodontic Association as well as an officer for the Florida Academy of Cosmetic Dentistry, and the Dental Society of Greater Orlando. He is also an officer in the Central District Dental Association and delegate to the Florida Dental Association. He has held numerous positions with national organizations such as the American College of Prosthodontics. He is a co-founder of the Digital Dentistry Institute, a leading contemporary education entity with courses all over the world dedicated to innovations and technology in dentistry. He is currently in private practice with Four office locations in central Florida in Orlando and east to the Beaches.
VIDEO - DUwHF #1259 - Sundeep Rawal
AUDIO - DUwHF #1259 - Sundeep Rawal
Dr. Birdi received his dental degree from the University of Saskatchewan and his post-graduate specialty training in both periodontics and prosthodontics from the University of Minnesota. He is a Fellow and previous Examiner for the Royal College of Dentists of Canada and a Diplomate of both the American Board of Periodontology and the American Board of Prosthodontics.
Dr. Birdi is one of the very few board certified dual specialists in periodontics and prosthodontics in North America, and the first and only specialist in the world to attain board certification in these two specialties in both the USA and Canada. He currently is acting as an executive member of the board of directors for the Western Society of Periodontology and the Vancouver District Dental Society.
Dr. Birdi is the co-founder of the Digital Dentistry Institute which is a global learning organization for his fellow dentists, and one of the largest dental educational organizations in North America. He is also founder of the BC Perio Dental Health & Implant Centres in Vancouver which is one of the largest and most technologically advanced multi-specialty dental centers in Canada.
Howard: it is just a huge honor for me today to be podcasting The Digital Dentistry Institute: everything on your left Dr Sundeep Rawal on your right Dr. Bobby Birdi let's start with doc on the left doctor son deeper wall is a private practice prosthodontist at Florida prosthodontics and the Central Florida area he graduated from the University of Florida College of Dentistry in 2006 and completed his training in prosthodontics at the University of California San Francisco in 2009 where he was exposed to the most current technology shaping dentistry he has worked extensively to utilize cad/cam technology within the scope of clinical dentistry and enhances patient's restorative treatments he has lectured across US as well as international with over 500 engagements over the years and published numerous papers in various dental journals and other publications dr. Sun de Waal is a past president of the Brevard County Dental Society and of the Florida prosthetic Association as well as an officer for Florida Academy of cosmetic dentistry and the Dental Society of Greater Orlando he is also an officer in the Central District Dental Association and delegate to the Florida Dental Association he has held numerous positions with the national organizations such as the American College of prosthodontics he is a co-founder of the digital Dental Institute a leading contemporary education entity with courses all over the world dedicated to innovations and technology and dentistry he is currently in private practice with four office locations in Central Florida east to the beaches uh to his right that handsome devil is dr. Bobby birdy DMD MSC FCD SFRC DFAC D the initials keep going and going he is a periodontist and a prosthodontist at BC periodontal health and implant center he's co-founder of the digital Institute he received a dental degree from the University of Saskatchewan and his postgraduate special training in both pareo and frost from the University of Minnesota he is a fellow and previously for the Royal College of dentists of Canada and a diplomate of both the American Board of pareo and the American Board of prosto dr. Bobby Bertie is one of the very few board-certified dual specialists in Paradise and prosthodontics in North America and the first and only specialist in the world to attain board certifications in these two specialties in both the USA in Canada he currently is acting as an executive member of the board of directors for the Western society of Periodontology and the Vancouver District Dental Society dr. berty is the co-founder of the digital dentistry Institute which is a global learning organization for his fellow dentists and one of the largest dental education organization to North America he is also founder of the BC pareo dental health and implant centers in Vancouver which is one of the largest and most technologically advanced multi specially dental centres in Canada gentlemen thank you both so much for coming on the show today to talk to my homies how are you doing Oh wonderful so Bob do you have some type of what what makes someone go out and get board certification in in not one but two different specialties
The Digital Dentistry Institute: just yes but now you know what to be honest I get the opportunity and the present itself and I just kind of took it so it wasn't something I had no boys to spend time on doing I just came on and I was able to just knock it out along the way so very lucky and behind because it's a lot of schoolwork
Howard: well Sundeep I was the first turned on to you when you did a dental town lecture with the Donna stairs ides my gosh on dental town that was an amazing course on implant dentistry and I wanted to get you guys back and get you on the show and talk about your new digital Dental Institute so - digital dentistry Institute so talk about your journey what was going on in your life where you guys decided you're gonna start the digital dentistry Institute what's it all about what are you guys doing
The Digital Dentistry Institute: sure well you know first thought powered thank you very much for having both Bobby and I on the show here are very excited to be here tonight and you know you said it right the digital dentistry Institute is by far been a journey for us really you know to summarize how it came about you know myself Bobbie and our other co-partners dr. Ron Zobel dr. sadi Raj you know we've been lecturing and being a part of education in dentistry for many many years now and over the years we you know came to see that there was a lot of really good relevant education in certain aspects of Dentistry especially when it came to things like the surgical placement of dental implants how do you do complex surgical procedures but the reality is dentistry has really changed dramatically in the last 10 years and most of those innovations have really come in the form of how do we apply technology this thing we call digital dentistry throughout all of our all of the ways that we offer therapy to our patients meaning diagnosis to delivery right from treatment planning to definitive restoration and when we looked at the landscape of where we were educating and and some of the focus that we saw in the industry we realized that there wasn't really a good cohesive message on how how to teach other dentists what these new innovations were with technology and how to implement them in your practice and how to treat their patients in ways that were more of fishing and and faster more predictable get better outcomes make treatment more affordable there's so much that technology's allowed us to do and we really didn't have great education cohesively in the marketplace and so a few years ago the four of us came together and decided that we were gonna embark on this journey and today you know we've grown to as you mentioned a global educational institute and today we do over 50 programs a year and 10 different countries Wow 10 different countries what are those United States Canada sure great so we've got United States Canada Mexico United Kingdom we are in Malaysia India Dubai Middle East Australia and looking to move into other markets such as China and the near future
Howard: Wow that is amazing so who is your core market I mean when you just walk out of dental school are you are they ready for something like this or do they need to spend a couple years learning their basic filling crown okay kinda like if your child started football the first year or two would just be a block a tackle a catch a pass when are they ready to go from dental kindergarten school to placing implants and start your curriculum well how long do you think that is no I think you're just
The Digital Dentistry Institute: well we offer everything for everyone so when people first come out of school and they're down in there just start getting started provide a lot of thought the initial education so they can learn to do something as simple as restoring an implant or implanting a simple case and really learning that the foundation the base as well and then they begin every others when it comes to digital technology vision very much into the Iowa standing whether they're gonna get into anyhow smile design or facial drive implants we're able to just you know a lot of kids to us was so good at technology already using their phones and using their tablets and getting on the internet and if we can provide but with just a certain amount of just a new way and whether you get some of the information they're gonna really take on often so we provide the foundational information because a lot of what we do North America and then we go down all the way up saliva surgical therapy and even full our therapy to some of the stuff that's immunity to the complex though we have something that the ground were you able to kind of start things off of them were able to progress we have things for specialists so these for general Dennis as well and a lot we're just really want to get into the field and allows us to really get you going and looking for coffee yeah I would and I would it be very clear on the number hmm
Howard: I know a lot of people want to believe a lot of things but there's this little thing called gravity or numbers or math that bring it on home like in the United States a dental specialist averages 320 in income whereas a general dentist averages 197 so if you're in still in dental school being a specialist on average earns a hundred thousand more than being a general dentist if you own your own practice you're a general dentist you average you net 244 if you're an employee you net 147 so it's worth a hundred thousand more dollars to own your own practice than to work for someone else but here's where these guys come in oral maxillofacial surgeons are the highest they net they average four hundred and forty eight thousand dollars a year parried on us at number two at three thirty endo number three 307 pediatric next 304 ortho 289 Pross two one nine 219 so what that inversely correlates to is blood dentistry is all hands on surgery and when somebody comes out of school two hundred and eighty four thousand dollars in debt and they say well you know I I don't really like blood I just want to do bleaching bonding veneers I'm like dude you're a doctor who sings them to be a doctor I mean did you mean to become an electrical engineer how did you end up being a doctor so these guys are teaching you how to place implants that's where all the big money is it's far more lucrative to pull a tooth and place an implant then all the bleaching bonding veneers like everybody right now I was talking about smiles direct Club smiles direct Club isn't gonna pull your tooth and place an implant that there in the non bleeding category so so when so when these kids walk into your course for your for core one implant treatment planning and restorations what letter grade would you give their dental schools I mean when they show up to you at a dental kindergarten class or are you like man they did a good job they know all the didactic basics or is this like talking to Pluto
The Digital Dentistry Institute: yeah the crisps come in and they hear a lot of things and they make Google things and look on YouTube and whatever happy but there's a large foundation because our essential basis and the reason why I also keep in a lot of times the dentist we try to make whatever we learn about a tooth or teeth and try to apply that to implants and the implants that I keep the same rules don't apply but we're trying to do that instead to turn a big symbol for ourselves but that's one of the biggest job was needed to break when we first up to yeah experience with patient participants come into our courses is somewhat variable to say the least look the reality is in dental education today there is so much that's changed in the last 15-20 years in dentistry that being able to comprehensively teach at all in four years the same amount of time frame that we spent learning you know what we learned twenty years ago but now we've got forty percent more information and forty percent more science behind that it's tough to do and then when you start layering in things like technology and how do we actually use some of the most state-of-the-art innovations that we have to actually offer those therapies therapies to our patients it can be quite challenging for anyone to learn all of that in a comprehensive dental education curriculum in school and so you know that's the impetus and why education and dentistry as an industry is tremendous across the board and it's a necessity really and so you know especially Howard when you bring it back to the numbers like you say and and really talking about the fact that in the reality of the economic drivers of Dentistry today yes blood is is so important in being surgical and it has a really high value dollar return in a brand of practice today but also on top of that is the use of the technology because you know where we may gain you know economic incentives to add additional procedures into our practice we can also gain economic incentive ization by taking our existing procedures and implementing technology today
Howard: now I'm why should they learn how to place implants when on your website you have Yomi the robot assistant dental implant surgery is here yeah I just stay home and drink beer in my jacuzzi and have my little yummy robot assistant place all the implants so that is that's a very pertinent question how and
The Digital Dentistry Institute: in the fine print it says robot assisted dental surgery so this is this is you know for me look I think technology is the one defining factor of our generation in dentistry today what implant dentistry was 25 years ago in dentistry in the Renaissance that it brought to our profession I think we're in the midst of the same Renaissance with technology and so embracing technology which includes robotics though it's robot assisted you can't be drinking the beer in the hot tub we still have to put our hands on the hands but the reality is you know embracing technology embracing better ways to offer therapeutic outcomes to our patients that's what you know you know Bobbie and I believe in in our private practices that's what we espouse through DDI and and that's you know making sure that we've got the best tools and technology to affect real change in our patients lives including robotics which you know will one day potentially be one of the most predominant mechanisms we have to do surgical procedures in dentistry
Howard: okay I want you to put your dad hat on first cuz sure I am I've been in a lot of dental schools for a lot of years there's two in my backyard and when they come out of school I mean they're honest with you know you can be at a bar with them having a beer watching a ballgame and they'll say look you know I mean they just graduated you know three months ago they say look man I I am not doing anymore molar and oh I've tried that twice both of them beat the crap out of me and I'm not I'm not placing implants I mean so so what do you say when they're 25 they've always seen this Cobra twice and a bit times and they immediately want to repel back into a vis align bleaching bonding and silver diamine fluoride and they need to put their big boy pants on and go get back on that horse that bucked him off and what what do you say to a kid if they're they're just kind of scared and say I don't know if I could place the implant because it's easy when you're old like means say look it's actually easier to pull a wisdom tooth I mean it's harder to pull a wisdom tooth than it is the place an implant on a first molar or maxillary bicuspid so so what do you what do you say to them when they're scared
The Digital Dentistry Institute: well I think the biggest thing I find for people like that doesn't matter if they're new or they didn't practice for many years they just you know I don't do extractions I don't I don't like I don't like getting crazy because they get stressed out about it a lot of times it has to do with the fact that you know we're taught a certain way and many surgeons constructs what they were taught didn't work for them or they don't know have a knowledge base or the understanding they wish to get about something to really be able to cue it well so those people we're having to come take one that's what one is for one it just ordered implanting where you learn why they're doing what they're doing and they realize the implants just you build the house it's just a concrete just putting in something that's going to help the foundation of what you gotta do so by providing them with more the knowledge base to be understanding doing - as our courses are all designed with the hands aren't every day of every session they're really going to get their fingers literally be able to kind of put the paper on the done that's big so on your on your core classes
Howard: so when you go core modules on core one two three four five those are one day one day class of course what there are three this is three courses there are three day courses so I so if I look at your next one September 13th so that the dates shown up September 13 is the first day but it's actually 13 14 15 15 yes that's great okay those are three day modules yeah so so do you have two should you or do you make them take them in order like you take module one before module two before module three they goes like that yes
The Digital Dentistry Institute: so that's a great question Howard you know the way we designed the curriculum was twofold one we wanted it to be something that could ultimately be a continuum for that that specific practitioner you were just talking about the young eager just got out of dental school I don't really know anything I'm a little timid I'm a little shy to actually embrace newer concepts or things like surgery because I just don't have a comfort level well we have a continuum that you can start with starting with something like core one working your way through all the core programming then layering things like our digital track ultimately graduating to live patient programs where you're actually operating on on live patients to master classes so that over time you can build on the complexity of your education as your skill set goes up we built it so it could be that continuum but at the same time we also built it so that each individual program is a standalone program so if I'm a let's say in an oral surgeon or a periodontist who's been placing implants for a lot of years but I'm not really comfortable with so large therapy I could jump right into a full arts program whether it's a didactic and hands on base course or a live patient course and get what I need out of that particular subject matter without missing out on something because I didn't start at the very beginning so we kind of we kind of designed the curriculum to do both of those things a lot you know
Howard: depending on what country are yet you see things differently but in the United States so much implant continue education is tied by the manufacturer so a lot of a lot of good assert or emailing me Howard at dental town comm or they put notes in the in the comment section on YouTube where they're saying in in my state or where I live I need to put the implant system first because all the Cee is sponsored by the deal so are you guys are you guys implant agnostic do you recommend a certain implant system where are you at with that
The Digital Dentistry Institute: so uh you know Howard we are our primary focus 100% is on education we believe that the most important thing that we can do is educate our participants on concepts on science on techniques and protocols utilizing you know technology to really offer the ability to treat their patients better in that conversation obviously there are different manufacturers different brands that whether implants whether it's interaural scanners whether it's CBC T's there's plenty of different products in the marketplace that you can use to offer those therapies you know our goal is to educate our goal is to make sure that patient understand the why of what we're doing and how to apply a bit more importantly to everyday private practice so that they can take the education that they from our courses and actually apply it on Monday morning but we certainly recognize that you know there are products in the industry and their brands especially when it comes to implants that you know allow our clinicians to be able to do certain things in ways that may be better than other companies so we definitely have P strategic partners that we work with when we're educating and we certainly highlight you know the benefits of why we choose the partners we choose but you know our number one focus is to educate and really to make our participants become better dentists in their daily practices I don't know Bobby you want to add to that you know how I'll say that another word reason or promoting anybody in our courses it's not because we're building them for a near Cydonia because we use the product and we passed got to use those products for many years so whether it's an iOS scanner whether it's a 3d printer or what the dental implant whether it's a prosthetic material all of it has to do with the fact that we use the product and now Beauty Bar our faculty conglomeration is that we've got 20 plus speaker is all using different systems different modalities different everything throughout the world and so we do have the ability to compare and contrast whatever we're doing and if anyone comes to the courses were able to help them out with ever whatever system you try to keep a message pretty clear and concise and in parallel throughout all of courses
Howard: you know on the three-dimensional printer do you know how to make it four dimensional all you do is just give it a little time so um so you're so you have twenty different lectures you all don't agree on everything but is there but if you had to give them one I'm gonna hold your feet of fire if you had to give them one implant company to start with give them one name give them one brand name no
The Digital Dentistry Institute: Biocare and white
Howard: you're a double specialist you're a periodontist and a prosthodontist it's it's very to me I think it's very interesting we're all the specialists I know pretty much are into noble bio care and I can't I mean if they got a CBC tea it's always an ikat why are they always I'm first of all do you guys notice that –
The Digital Dentistry Institute: I'll tell you that the reason why not I can't he's been classically utilized most surgical offices surgical specialists because if the field of view that was offered with the first came out with the Machine and it's because they were in a lot of schools and the talk I haven't I can't flex and I love it it's a it's a great machine the radiation goes at this point is the lowest pretty much in the world and the smallest amount of time and it's a great amount of information gained so you learned to use I can't when you were in Perry Oprah school about you we had a few different systems when I was doing my prosthodontics residency as I count one of them I count was one of them you know today you know working with various different companies throughout my four offices you know we have cave o scanners CB CT scanners and in the practice we have a thoroughness scanner in our practice you know we tried to embrace multiple technologies but you know I think you're absolutely right that from a specialist standpoint they have gravitated to certain products you know especially when it comes to dental implants and things like noble care you know a lot of that is steep in the in the in the history of you know specialists trying to use you know products and the services that have been I think you know tried and true tested with evidence-based dentistry with the longest historical run with you know a proven track record and you know when we look at that and you know when you say hold your feet to a fire and what would you pick for an implant system across the board um you know we Bobby and I both agree that you know we both in our private practices used mobile bio care because it is one of the longest standing implant companies in the world if not the longest it is 100% to have some of the most science out there compared to uh some of the other newer implant companies and it's one that we feel comfortable not just educating on but more importantly we feel comfortable putting that in our patients mouth they're gonna be here I mean like we're talking about a large company that's in the foundation of implant that you couldn't very long time and I think that's a big deal with companies and obviously goes compared to about the automotive industry where you have newer smaller companies coming up and then they the economies can't find parts and whatever having I'd rather be working with a company that I know and I can feel fairly confident that
Howard: so Sundeep you went to a University of California San Francisco right yes I did dr. brand marks son is an orthopedic surgeon in that town did you did you run into him I did not I did not know that he was an orthopedic surgeon in that dad was an orthopedic surgeon but yet I mean they started testing you know in titanium they weren't gonna test artificial hips on mice so they just stuck pencils and mandibles but his son is an orthopedic surgeon just like his dad in San Fran but I can remember when his dad came to the United States only only oral surgeons were allowed to learn and then after a while he lowered the bar and let you know the periodontist walk in there
The Digital Dentistry Institute: but you know but there was a rationale for that sure because at the time with P I I mean the thought process was that an implant had to be placed in a completely sterile environment and some of those sterile protocols that we even have to this day for implant placement and so when he first brought implantology it's North America and he said well this needs to be placed in a sterile environment who had access to sterile environments at the time right lately agree with this protocol but
Howard: where I was going with this question is when you look at the I always tell Dennis if there's any dental company publicly traded you gotta buy one share of stock in and so that by law they have to mail you there are ten cues there quarterly reports or 10k reports but you just get so educated on this industry and when you're reading the shares of like straumann which is the largest implant company in the world because they've mergers and acquisitions they bought neo Denton Brazil they bought they've all these companies but they but one of the reasons their stock is so well is because they show that in countries like Korea and Germany three out of four general dentists placed an implant last month but then when you go to the big mark of the United States it's not near that and so there's so much up growth in that so you're in Canada you're in Florida I'm in Arizona that's kind of really pretty much the same country why do you think general dentists in Korea South Korea and Germany and for a Spain three out of four general dentists place to implant last month and we're not anywhere near that in the United States and Canada and do you think that's gonna be you think that's gonna be changing do you think in ten to twenty years will be more Korean and German than we are today
The Digital Dentistry Institute: I mean for the states and that let Bobby kind of touch on Canada since you know these are a resident expert up there you know I think I think a lot of that has to do and especially you know with the fact that you know we educate around the world and so routine the you know our team including myself and Bobby where we're flying constantly around educating and seeing what's out there in the different countries in their different marketplaces there is a significant there's two factors there I think one factor is the paradigm of what is traditionally within the scope of the general practitioner in other countries if you go to a market such as Korea you go to low market such as India for that matter much more advanced or complex procedures are done by the general practitioner compared to what's done in this country and therefore they're much more readily right they're more ready to adopt things like implantology into their practice there's much more of a single center mentality when it comes to offering care in those countries and therefore you know the general practitioner needs to be trained to do not just implantology but quite a bit of other surgical specialty procedures that otherwise would not be done in this country so I think there's that paradigm of what the scope of the generalist does in those countries that affects that and I think the other part of that compared to the u.s. specifically is our model of payment and reimbursement compared to insurance based healthcare systems when you look at this the dentistry the dental market in the u.s. especially when it comes to procedures like implantology we are very much in a discretionary dollar environment right it's elective procedures it is discretionary dollars where you know patients pay for those procedures out of elective monies which means you know they don't readily accept treatment where they may in a country that has socialized dentistry where you know their dentistry is covered through their overall insurance plan and therefore they're more readily to accept it and therefore the the number of implants you know for generalists that get done is much higher I mean I think that's a definitely striking issue when it comes to what your your comparison is in the states I don't know Bobby what do you think about Canada some of the things that I know is that per capita the number of implants are placed general Dennis are Prince's implants care inside the u.s. in terms of 478 capita and I think someone has to do with the readily available specialists in certain markets and having the ability to work with them when we go overseas and go to other markets or there's Korea Germany other parts of Europe the single care provider type of therapy where one clinician is doing more and more he's not only becoming more prevalent it's also becoming more of a cultural thing specially in Asia it's almost you know the other types are doing everything and longer fur there's an absolute problem or an issue and I think in both the US and Canada we're gonna see more of that where my office is much very much a one-stop shop pretty much a multi-specialty multi you know lab and everything and we are one stop place where we can do everything and I think that is going to be more and more of the future of about just devastating this type of field going forward work you walk in someone who can supply everything for you whether it's one practitioner doing it all or whether there's a team I mean we're gonna see that more and more North America just because of that reason now in terms of the insurance side of things Canada's very tripping that you ask because yes we have their insurance but people paint us as dentist first and get reimbursed by the insurance afterwards so this discretionary this private bit where is if you in the country such as you know whether it's under other countries where they have socialized dentistry then you're right it could be quite different depending on the market so I do think we well become more like that over that's wrong you've messed up ears you think so much more like what like switch much more like like like South Korea everyone sees more and more practitioners place it's gonna be the number of implants placed by general dentist is greater than half of the ones about the America last year and so most of the general dentist didn't place more than 20 implants in general but this is just a larger number of them and because of that reason general dentists are able to be more that's fantastic to be able to provide service to the patients
Howard: I think I've always thought it was bizarre that the continued education courses never matched supply and demand like if you go to all the major made they always bring in some heavy hitter to talk about and all on four whereas everybody in the audience does all on nones and you know I always want to interrupt and say okay raise your hand if you've ever done all on four and nobody raises their hand and it's like okay where's the course on the all nuns because everybody in this room did a denture this year so you know is it the same in implantology where you know the majority of the implants would take crowns 96 percent of crowns are placed one at a time every time I look at implant data it's the same thing you're placed one at a time but all the lectures are all on four you know it's always somebody doing some supermodel and a you know in a swimsuit edition and she needs you know an implant on her front tooth or something that but isn't is it what I when I sit with my insurance friends and there's 32 teeth all the dentistry is done on for six year molars the first molar is most likely to have a Modi filling a crown extracted an implant a root canal so the four big monster spikes are the first six year molars and in fact when that six year tooth comes in I mean why would you do a sealant on that - that - most likely to explode and kill the person sitting next to them I would want to clean out the pits and fissures and do a preventative resin restoration I mean I whenever I see a six year molar pops ooh I mean that's the class clown that that's the kid in the mouth who's gonna get in all the trouble not the one in front of them behind them that's the troublemaker so as is a lot of your curriculum teaching real world first molar one implant dentistry on replacing that one 6-year molar
The Digital Dentistry Institute: absolutely I would say most of our most the core building core programs for working for or to help address just that normal their most implant cases are one to two implements per case and that's where that's where poor watching sports that's what it's about you can clarify that's what it's about yes we'll be anterior implying restorations and provisional restorations and type of surgeries that involve as well to address what 90% of 80% of implant dentistry true for years and more to that point it's also very important to us that everything we teach in those course is very practical and can be applied on Monday morning to your everyday dentistry I mean you've got to remember Howard that you know when we started this company was started by four private practitioners you know everyday dentists who get in the trenches on Monday morning at 8:00 a.m. and so it was really important to us that all the concepts that we teach are pertinent to that that average private practice the guy that wants to place the one in plan in that maxillary bicuspid wants to learn how to place well want to learn how to place it efficiently wants to learn how to place it easily you know that's where we gear 9% of our curriculum through those concepts and
Howard: when you know the patience is when you're young when you're a 25 year old dentist you can get talked into a lot of trouble by an older patient talking you know hey come here walk off this cliff for me and you know you do it when you know you don't do it when you're old you do it when you're young and they want that tooth pulled and the implant placed and loaded be they want to walk out one stop shop one appointment where do you balance extract immediate load for cosmetic concerns and real world will this hurt the life expectancy of it
The Digital Dentistry Institute: no I would say that when it comes to loading single tooth implants that's kind of where I live doing that all the time placing them really ignoring them their only reason to lower in my humble opinions in an implant for a single tooth is pretty much aesthetic purposes in the Arizona let's say most areas probably do them once in a while for some patience everybody big smiles or they didn't want that too but it's we place the immediate mode of a single tube restorations an advanced procedure and it's not something that you know specialists feel comfortable doing all the time so it's almost things where you have to kind of walk before you run and when you get to that point you placed some implants and you've stored them in to visualize them already gone through the whole process then you can start looking at doing those things and spend the time yeah I mean I couldn't agree more I think I think the crux of the matter is we've got good scientific literature you know with long term data that supports some pretty defined protocol and criteria for when we are even able to consider immediate look and you know things like getting good initial primary stability on the implant when you place it to be able to load it at the time of surgery you know these are things that you know we teach in our courses because you're right it's easy for that young dentist to get talked off the cliff and get thrown to the Wolves you know by the very person that wants them to do the procedure and so really the clear defining differential in that is a knowledge base a sound knowledge of when to do certain protocols and why to do them and do you have a reasonable expectation that they will be successful and so you know it really comes down to education and being taught when you know it's okay to do things like immediate load and when know it may be a little bit too risky for this particular situation
Howard: I've noticed one thing that's been gaining popularity more and more and more is a more a traumatic a way to extract the teeth I remember going to Cologne Germany a decade ago and the Germans were you know selling different instruments and you know go around the terrianna ligament and loosen it up and all this kind of stuff do you think it's really starting to take off or do you think dentists are still just going in there with a small elevator and forceps and traumatically extracting a tooth as opposed to a dramatically extracting a tooth
The Digital Dentistry Institute: I think that that's one part that with some dentists to a better and better job and if you see this more and more I mess through what our core 3 program is in traumatic for action a large part of that of course you can learning how to go about this and some simple tools and tricks so that they can hear we go about this nature not compassion if you want to be able to do any kind of implant dentistry or any kind of you know really good now see I think you have to be as economic as possible what you're doing and then each night extraction it's getting better he's not normally to go yet but I think that is in general or better than and I think that lends itself to the fact also that you know and everything we're doing in dentistry today whether it's an extraction whether it's a crown prepper of veneer prep or a implant we we've realized over the last you know 10 15 years that these concepts of minimally invasive dentistry and doing less can be beneficial is definitely a paradigm that pervades everything that we do and I think that that translates especially with attraction to you know doing those attractions and the least traumatic way possible and also on extractions there are a lot of people who do PRF platelet-rich fibrin techniques with it and
Howard: in the same medical dental building there's Dennis who don't ever do it and it's confusing to these kids because like son keep your and your son deep your dad's a dentist right yep he's honest he's a process honest so it's obviously some type of genetic disease and you should you should not have any children only adopt but it seems like when you go into any dental school around the world especially in Brazil and India and you say raise your hand if there's a dentist in your family at least 1/4 of the hands go up I was one families in San Paulo Brazil where this one family tree had 35 dentists in it and you probably never heard of the guy I was talking to uh Kevin coachman I mean it's like and I was in New Delhi and this dentist had this house and it was connected to all these anyway there was like 12 or 15 dentists in his family tray living there so so it's very confusing when you want to be a dentist just like your dad just like your mom and you go there and like say you're a prosthodontist and your mom doesn't even own an articulator and you hear about these techniques like PRF and your mom says oh that's that's crazy stuff that's crazy talk so so what do you do your dad's a prosthodontist so you've probably had differences in protocol opinion last year for sure so how do you handle that
The Digital Dentistry Institute: well I think you know look I think when it comes to this you know dialogue honestly Howard it really comes down to differentiating between what I'd like to call with my dad you know principle and protocol so there are going to be certain principles certain reasons the why of what we do whether it's you know the material we choose to use for a crown or you know what materials were using at the time of surgery that we know the principles we know what principles work we had those principles in dentistry for 20 30 40 years well when it comes to protocol meaning how do we actually execute on that principle that's where things change and it's really important you know especially in my own personal experience with my own father you know I was really blessed that he was open-minded enough to say listen I think that we should be doing it this way because of the principle but I can recognize that with technology with the advent of better science better materials better engineering better software there might be a better protocol we can follow to get to the same goal and I think that's really where the difference is especially when it comes to embracing these newer concepts you know not saying well that's just all hogwash because I've been doing it for 30 years and my way works but more saying listen my way works because we're following these principles and if you use this new in a datian you're following the same principles you're just taking a little bit of a different back
Howard: you guys are both prosthodontist correct absolutely okay her mom doesn't own an articulator and says you don't need one
The Digital Dentistry Institute: continue that conversation through my board exams and having called Driscoll and Jonathan Winston's from like 1900 all the way through and having a memorize everything I'll tell you that you know having an in-house lab with technicians where else do we even articulate yes we do do we use a particular guide used when I was emergency absolutely not you don't and the reason why is because everything is so digitized from officer uses in terms of articulation in terms of digitizing our models everything we're designing everything was doing is actually on a on a screen you know my lab is a fraction of the size of what a lab in 10 years ago because it's mostly just computer screens and males and Prentice and so one of those things where didn't articulate I think we definitely do for lots of cases still but I think that was getting boring digital where the software's are able to go for will be able to provide articulation and the motion of approaching your Iowa's and that Grover Blaine are technologically that are the amazing people but I don't think we're ready to give up I think we're doing going down that road no I totally agree I do a lot of my cases they through a fully digital workflow where I'm using the best articulator in the world which is the mouth and a virtual representation of it I'm not even using an analog medium to replicate the mouth on some sort of machine on a bench top anymore so I totally agree with you Bobby I think what it really artists to use power to your point your question is you know it if you know the mom was saying I don't use an articulator and I don't need it and I still get great results I think the question is in well is the articulator needed or not I think the question is well why do I want to use the articulator if it's something new and something that I think is innovative and it really allows me to accomplish the same goals or the same principles principles through a different protocol but that protocol now takes me half the time instead of not using an articulator and doing it in 30 visits while I use an articulator I'm doing it in 10 or where we are today with using analog protocols and maybe doing a restoration in 10 visits well now digitally we can do it in 2 I think that really is the question you have to ask yourself you know is that new concept or is that new piece of equipment or is that new technology is it allowing me to accomplish my goals in a better way a more efficient way a more practical way or at least a less costly way right which translates to more affordability for our patients if you can check those boxes with that new concept for innovation then yeah I think you should try and embrace it into practice if you can't check those boxes if it's something where it doesn't offer those benefits then maybe update you step back and say hey is it really necessary how close are we to virtual articulate errs and virtual Facebook transfers in prosthodontics I think yeah I mean I would tell you that for a lot of things we're there I mean Bobby Bobby can agree but Bobby in Bobby's lab as he was alluding to you know for a lot of restorations they will be totally digital model Asst they will only work in the digital world based off from a totally virtual articulator and you have to remember yeah you know from a standpoint of logic and articulator is our best guess of what's happening in the mouth
Howard: what is your go-to virtual articulator
The Digital Dentistry Institute: I would say it depends on the software using a lot of times we using pre-shape to help us to do it and help with a lot of emotion that we have but then all depends on the modules you have lab for software for that we use that tremendously that's pretty much our go-to little bit of dead links in there but in general I think the shape is our number one but it has a lot of different articulate errs that you can pick in their software right yeah so we said in our practice we said average values I mean look we base that a lot of things on a again sound fundamental principles back to my point a little earlier the principles don't change right if we're going to design an occlusion on a analog articulator and we know that we can set that articulator to certain averages to accomplish the goals that we are trying to achieve we follow those same principles but just in the digital world where we set averages based on the same principles that we've had in in dentistry for the last 20-30 years and that could be different for me than it is to body but whatever he believes in in his philosophy he can he can replicate that in the digital world and I can do the same in my digital world and then based off of that we can you know design and create the restorations as needed now that that's going a step further because as Bobby alluded to we are now able to capture dynamic records in the virtual world meaning we can see how a patient's own mandible moves with relation to their maxilla and replicate that in the virtual world to create a truly custom fully adjustable articulator which is the patient's mouth
Howard: okay I'm gonna hold your feet to the fire though you're you're saying sound principles stay the same but protocols change okay and she graduated she's with her mom and she's in this town right and her mom says you know look I placed thousands of implants and I've never done this prf thing one thing voodoo you don't need it what would you say to specifically regards to PRF
The Digital Dentistry Institute: so I'll take using PRF in my office for every surgery for the last five years everything before that I'd live another it's not that you don't target get the results fidelity it's like everything else it's not that we can't bother using old bonding agents and old Koppers that are composite so you couldn't use amalgam you can use all the products of different with the three things right but today people are doing sockets you learn other things as well it's not that we could have two things previously is that is it getting improved do we get improvement and I will tell you that with PRF we do see clinical assault smokin soft tissue in the car tissue there's results now women showing that we're gonna get into celebrated his falling in certain aspects in special immigration when it comes to the infection rate but when the best articles published surgery distressing was that a deep in post-operative x-rays and third more extractions it's just like you may get less complications with it and you might get overall just a better result standard what's your increase okay
Howard: now I'm gonna ask you a question and you're gonna think it's dumb and you're gonna think I'm stupid but I'm this is dentistry uncensored I keep it a real I get a lot of emails Howard at dental town calm and I know these guys but the bottom line is this if you point out anybody in the United States who has placed over 5,000 implants today okay they're old and they did them all on what type of radiograph so I have friends who are with their dad and their dad saying I placed 5,000 more implants than your teacher and I did every one of them with a 2d to degree too deep a no what do you say to dad
The Digital Dentistry Institute: sure we only hear this argument dentistry the reason why is in dentistry every single person in their practice is the king or queen of their village of they're hot they're of their castle and they've done it their way their protocol and the member compared what they do from how they do it with the next first there's no standardization across the industry and so when some persuade for so many tears were teleported because it worked in their two hands but this is gonna work at someone else to max so when someone says that he's five thousand implants and he's a 2d image I place the first thousand implants pretty much I place to put 2d image I use of cpct every every kits now why because it's better I can plan better I have to belong to every what I'm going to do is better I'm able to do things overall better there's a result that over time I would say yes because you're gonna get less complication long-term and we understand things better it's just a matter of now we build a house we don't just don't do we did 20 30 years ago you get 3d renderings and to get other images to do that the reason why is because we can plan yeah and I would take it I would also take it a step further and you know when I talk about this very subject I mean how are the answer to me isn't well you've done it with 5,000 implants with a two-dimensional radiograph and therefore you don't need three-dimensional CB CT because if you look at it from that very linear black-and-white do I need it or not you're missing the big picture because the big picture today is it's not about the CB CT and looking at things in three dimensions it's about the cpct looking at it in three dimensions and then as bob easy to do using that data putting it into planning software creating a guide or going into robotics or creating the definitive restoration and then delivering that at the time of surgery you have other applications because of the technology so it's not so much do I need a CBC T to place implants if I placed 5,000 implants before no but if I want to be able to offer a better experience to the patient do it with less time have less potential complications have better outcomes and be able to do more in one visit or be more efficient then yeah then I need to start embracing some of the newer innovations that are out there
Howard: another question I'm a lot of people are starting to say that the the need for a sinus lift is going away quickly because as implants get shorter and fatter it used to be they had they all the implants are the same and you had to have a really long implant preferably one that goes all the way out the back ear head around the moon a couple times and comes back with a bolt on it but with a really short fat and I want to be the poster child to support anything that's short and fat so III want to get behind this but are short fat implants going to replace a big bulk of sinus grafts and sinus lifts
The Digital Dentistry Institute: I think so absolutely implants I would say the king direct sinus the sinus bumped where do most positioners have five to seven to eight millimeters polished there's a really hard to justify putting in something that acquisition he looked at by coronation of a plan without indirect was a short implant and there was no difference in the results over time so I think when it comes to indirect sinus tract and when it comes to doing portal fixation or having a short implant I think we're gonna see less and less that all the time I think the direct sinus trap you always in those cases you have nothing to put more into tap to graft well when it comes to those procedures yeah we do less of them now can still log just the amount of bone you have all the scientists that engages to get it is directly correlated to the most you have long term and that's that's so short implant I've found as a surface area that's better than something I already dressed something else
Howard: um one of the things that's really stressing out a lot of people is they go back to their mom and dad their mom and dad saying let's do these implants it's all great and groovy and she's just seeing a ton of peri-implantitis and it seems like when someone needs to have their tooth pulled and get an implant they're usually not the yoga instructor they're usually not the vegan usually I mean I'm in Phoenix they're beer drinking cigarettes smoking I mean I know Florida is the highest class part of America so you might actually they call Arizona the Florida of the West so that shows you how how crazy you're in Florida and I'm in the florida of the west and a lot of the people that come in that the young kids are like well you're not supposed to put them in smokers well why all my patients lose their teeth because they're a smoker I mean I supposed to every reason you're not supposed to do an implant is why they're in your office getting their tooth pulled you know what I mean so you know so what do you do when the person that comes in is a smoking drinking Irishman with a pack of Marlboro in his pocket and and then the one you put in five years ago has peri-implantitis um you know how does how do you juggle all this
The Digital Dentistry Institute: so you know what I would tell you and I'll let you know Bobby being our resident Perry o frost it will forded guy jump in here without what I would tell you is that you know you bring up a very good point in terms of maintaining the health of implants versus just have the implants being stable in bone and that's something that we have not talked about in Dennis till over the last 20 years you know there's this big concept or big discussion and dialogue in dentistry about success versus survival and just because an implant is you know solid and bone doesn't mean that it's successful if there's you know some peri-implant you know issues around it I will say that you know this is a really interesting topic of discussion because no peri-implantitis is some that is in the big you know elephant in the room for a long time we don't have any clear consensus of how to define it is it very implant inflammation very implant mucositis very implant infection granny flat bone loss and then we don't have really any good consensus on how to treat it and what the prevalence of it is in the in the industry or in the in the in the you know marketplace so it's really one of these areas that we need further discussion we need further science to tell us what are good protocols to follow to help mitigate those kinds of issues Bobby no I think house like you said all guys only need implants other people that learn about saying with the apologies you would hire I never we have friends all over the world think it's bad Mary's owner of Florida Mexico her friend he said he didn't place implants also occurs temples so in the smoke for us making the smoke we are taking a conservative approach and places and planet waiting the log onto it you know great about these men also informative patient them know and say listen this is something that you're but you're doing that is now gonna affect the long-term was also and know what's and everything else that's part of them you know there's only so much you can control as a practitioner so much you can do and you there to provide a service and you're gonna do that whether it's a smoker or someone who's not prayed all disease or whatever have you you put the one prayed all around them he's gonna get to go finish therapy and go through all the treatment great if they're not well then their implants at risk
Howard: well you know if I couldn't treat beer-drinking chain-smoking hillbillies I can work on any family members so you know we have to we have to do that I can't believe in an hour has gone by and we're already over an hour but is there is there anything the the problem with peri-implantitis is there's no pain the patient loves the implant then go to McDonald's and chow down on any hamburger french fry or they can they love it but she's sitting there and there's five six millimeters of bleedy hamburger gums around this thing and then she's reading about all the oral health you know issues of peri-implantitis so what do you what do you do what's the protocol when patient loves it but it's peri-implantitis information' our office now almost 25 years in France place that we've been maintaining and burn time to deal with issues that are part of the office and we deal with it every week and
The Digital Dentistry Institute: just constantly saying listen you know implants has lost bone and and if we don't do something about it the continued and the crab that always the thing is do persist through the pain to show them damage over the back with a neutral photo inform and educate the patient to know what is reason everything to understand that an N plus not assume he's not an herb that's gonna help them understand or ligament around that's gonna help them understand a few can paint a problems and that's why also re cost Angeles three to four months because six months for that same reason is so that something does happen we catch it early otherwise it's a disease I also think it's important you know we've kind of had this false notion in implant dentistry over the last you know 10 15 years that implants you know are almost infallible you know if they integrate early on you know they're golden and nothing can ever happen to them they're gonna last the rest of your life and well that's not really true I think you know we need to respect the fact that we're implanting a medical device in the human body and it is the most complex implantable device we have in all of Medicine because it's the only implantable device that has to live inside the body and outside the body at the same time and so we need to respect the fact that you know it is not a perfect science and thing can happen and that's why it's so imperative that we are very proactive about educating patients about selecting the right patient about making sure we're maintaining them in the appropriate ways
Howard: so did you do have a Yami now are you using Yami
The Digital Dentistry Institute: so I do have Yummie we've actually had you owe me for a little over a year now it is it's a system we adopted we you know we were very blessed that you know the company osis is based out of Florida and so we got in early on in the in the entire process and so we've been doing robotics now in with implantology for a little over a year and really we're excited about Yomi and and the possibilities of robotics in dentistry I mean obviously currently we're using it in implantology to create osteotomies for implants but the applications are really limitless I mean we have the ability to do things like you know bone reduction protocols we have the ability to do things like or thematics eventually even get into restorative and operative dentistry and you know manufacturing whether it's chair side milling of restorations you know there there's a ton of secondary tertiary and and so on applications with robotics that you know we're really excited about it's it's eliminating the last frontier of inaccuracy in in our operations which is you know the human and
Howard: well I'm just waiting on till neurosis comes out with a robot assisted wife I I'm waiting to remarry when it's a robot do you know how much further that long that will be you know
The Digital Dentistry Institute: my sources tell me that that won't get FDA clearance for a little while longer never still come back and that's never kind of and you know the my only advice on I ever 10 minutes over is um you know
Howard: I really liked what um the pain Kian suit did and they on dental town see II they realized it was a big gap to go from I heard about the pain key to go spend a week there and you guys got these three day courses I'm so what pinky did is they made it one hour online seee course that summed up that week and it really was a great marketing effect because it kind of bridged the gap between you know I'm trying to help these kids make a decision and flying off to go see you for three full days I'm doing this you know I'm trying to get you know because I know if they could hear you they would fall in love with you I loved you downtown course but you might consider you've already done an online C course with and Onis I I think you should do a one-hour course to explain your three-day core courses so they can meet the instructor so they can start you know the getting in the moment I think it'll be I think it would help them to pull the trigger and go see you guys I love everyone
The Digital Dentistry Institute: you must be psychic because that was one of the things that we were gonna discuss with you we we actually think that that's an excellent idea and we were actually planning on creating those one-hour kind of introductory videos that that we could utilize on dental town to be able to promote you like you say that transition from hearing about us to seeing what that specific course is to actually attending the course absolutely
Howard: it's I just you know I want it I wouldn't help them pull the trigger you and I mean and I wasn't will push them you know the dentistry is all you work with your hands doing live surgery in an operatory and if you're afraid of doing surgery on a live patient and operatory I'm not gonna listen to oh you're gonna go be a bleaching bonding smiles direct Club oral scanner I mean no you're gonna get back on your horse you got scared you got bucked off I remember when I got bucked off my first or you can't make this up I was only ten the horse's name was lightning you know that you probably you probably should have known at ten don't get on the horse named lightning and it bucked me off onto an electrical fence in Fort Scott Kansas and I'll never forget his mom Judy huff said uh no Howie you're gonna get back on right now you're not is the longer you get off and think about everything that went wrong then you're gonna be afraid of riding a horse the rest your life so dentistry is surgery it's blood and guts it's all done in operatory oral surgeons make the most money periodontist knacks your chain-smoking alcoholic good ol boy Irishman who lives in Arizona while his cousin lives in Florida I'm sure they're gonna come in they're not ideal patients but they're good people and this is what we do this is why we're Dennis and I applaud you guys for teaching I applaud everything you do and it was an honor for me to be able to podcast interview both of you guys today first thanks so much out it's our pleasure and this little girl that adorable little girl that came in is just like dad she wants it does she have these you know something in the water here in Florida are well maybe maybe you should do 23andme you and your dad more daily they'll be too much acrylic in that report all right well hey thanks guys for all you knew thanks so much for coming on the show today