Dentistry Uncensored with Howard Farran
Dentistry Uncensored with Howard Farran
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1266 Dr. Christian Kenworthy Talks Custom Digital Orthodontics : Dentistry Uncensored with Howard Farran

1266 Dr. Christian Kenworthy Talks Custom Digital Orthodontics : Dentistry Uncensored with Howard Farran

10/3/2019 6:00:00 AM   |   Comments: 0   |   Views: 141

Dr. Kenworthy attended Brigham Young University for his undergraduate education. He received his BDS and DDS degrees from the University of California at San Francisco, and his orthodontic certificate and a Master's degree from the Mayo Graduate School of Medicine.

VIDEO - DUwHF #1266 - Christian Kenworthy

AUDIO - DUwHF #1266 - Christian Kenworthy

His writings have been published in the Journal of Orofacial Pain, the Journal of Prosthetic Dentistry, the European Journal of Orthodontics, and the American Journal of Orthodontics and Dentofacial Orthopedics. He is an active member of the American Association of Orthodontists, completing his term as president of the Rocky Mountain Society of Orthodontists in 2016.

 He has not had impression trays or alginate in his office since 2014.  This has allowed him to become more accurate and efficient in his delivery of custom orthodontic solutions. He is immersed in digital orthodontics and enjoys sharing the solutions he has found. Dr. Kenworthy's Missoula, Montana practice supports all the fun he, his wife, and their five boys can find.

Howard: it is just a huge honor for me today to be podcast interviewing Dr. Christian Kenworthy: DDS MS he attended Brigham Young University for his undergraduate education he received his BDS and DDS degrees from the University of California San Francisco and his orthodontic certificate and a master's degree for Mayo Graduate School of Medicine his writings have been published in the journal or facial pain the Journal of prosthetic dentistry the European journal of orthodontics and the American journal orthodontics and dental facial orthopedics he's an active member of the American Association of orthodontists completing his term as president of the rocky mountain society of orthodontists in 2016 he has not had impression trays or alginate in his office since 2014 this has allowed him to become more accurate and efficient and the delivery of custom orthodontic solutions he is immersed in digital orthodontics enjoy sharing the solutions he has found dr. ken worthies Missoula Montana practice supports all the fun he and his wife and their five boys I have four boys he beat me by 20% dr. Kirsten Kenworthy has published poetry coached semi-professional baseball written a few novels and led Boy Scout troops he and his wife and their five boys enjoy fishing hiking four-wheeling camping skiing and other outdoor activity that western Montana has to offer by the way to the international viewers I live about a thousand miles straight south of them and everybody in Arizona tries to figure out how can I be in Arizona in the winter in Montana or Canada or Alaska in the summer I  think the area where you live is the most beautiful I don't want to serve anything negative but this is dentistry and censored and in the news today three orthodontists have  sued they launched a lawsuit in Nashville against smiles direct Club and theirs I just can't I don't want to bring you orthodontist on the show without at least starting because it went public this month couple of things went public this month um Danaher spun their dental division and I think that's really cool because when I got out of school 30 years ago Siemens which is the largest company in Europe kind of like Procter & Gamble Johnson Johnson the CEO decided they were too over weighted in health care so they spun off Sirona and the building didn't change the people didn't change but they're they're the parents that didn't want them were gone and they just blossomed for 30 years and I'm sitting here thinking my god Dan or her own some of the greatest dental companies in the world and their parents didn't want him you got five boys they'd all run away from home tonight if they thought you didn't love them or want them so I'm so Danaher spun that off that went public but smiles direct club went public and it's the most controversial thing in your profession that you've probably ever seen have you ever seen anything more controversial than that 

Christian Kenworthy: no it's crazy actually so we have I probably get asked and probably every orthodontist does I get asked I bet three times a day on average where somebody says hey what do you think of that Do It Yourself a liner thing is that going to work like people are seeing it their advertising dollars are working and it's getting people thinking about it but I think a lot of people are skeptical and the problem is at least what I tell patients is you know what I wouldn't move somebody's teeth without looking at an x-ray I wouldn't move somebody's without checking their gums out I wouldn't move some of these teeth without knowing where their bite is and knowing what they really want and all those things are really hard to determine from a self-made alginate impression so anyway we do I actually do a liners in my office and I charge 200 bucks a trade and so for pretty much what you know the 2000 or $3000 that Smile direct Club is charging I can do a pretty dang good job for about that same fee and people just don't know you know what they think is Invisalign cost sixty-five hundred bucks and this costs two thousand or three I'm gonna do the they think it's the same thing it's all just a liners right so they just think it's the same thing so I think what the little education people will make the right choice most of the time so um well you must yeah 

Howard: so you're saying Invisalign usually cost sixty-five hundred and invisi and smiles direct Club what would you say that usually cost 

Christian Kenworthy: I think they advertise that they'll do things for about two thousand but when I talk to patients they say that it ends up costing more than that so there must be some other fees for something else I don't know I've never used it but I think they're advertising says they're about half of what Invisalign costs at the orthodontist so are is there actually Invisalign shops in Montana there are there's no Invisalign shops like there's no offices where you can go get scanned directly for Invisalign and they'll send you to the North Dallas there are plenty of orthodontists who are doing Invisalign and plenty of dentists we're doing Invisalign but there isn't a standalone InDesign shop okay 

Howard: so I'm smiles direct Club I'm you seem Hittite but by the way people last night I thought I you know I'm gonna go on prepare for my interview with Christian Kenworthy and I am you have written for ortho town and I knew you were all that about your chips my god if you google this guy's name there I mean he's associated with I mean you are so high-tech all this about free in the high-tech that they're following that lawsuit today so do you do you think that's where this is gonna do you think this is where it's gonna end up that it this is something that is it gonna be pure and clean competition or is gonna be no this is just needs to be shut down in courts how do you see that 

Christian Kenworthy: I think the biggest problem is they don't use a dentist and so they are unless they've got somebody that's licensed in Montana they're not practice with a licensed bass I I bet that's what the legal action is and the problem for patients with that is they don't have any place to turn for recourse you know if something's happening wrong they have to email back to this company they get another box of alginate that they can goop themselves up with and somebody else but nobody's ever talked to them they can't go to somebody's office and say hey this is bugging me this doesn't feel right and so I think it's the practicing outside of the dental practice X that's the problem but I don't mind competing with them I compete with anybody you can move to Montana I'll compete with you

Howard:  huh come on you got one more boy than I do fight boys against four I'm not I'm not that's so basically what he's talking about is um this is the case so it's three orthodontists their names are dr. Joseph sissy Oh dr. Vishnu Raj dr. Arthur Coppola Capet and they launched a lawsuit because let me read this legally right plaintiff a patient Dena is a resident Michigan who purchased the liners from smiles direct based on defendants written fermentation small direct developed a plan of treatment to correct among other things snaggletooth and representative that her snaggletooth to be corrected however smile directs liners in fact worse in the snaggle to did not correct its placement and causes snaggletooth to become loose and sensitive so so basically what you're saying is when there's not an orthodontist era it's to tell a dentist remodel so so is this a tell a dentistry technology I'm in your as high-tech as they come we're where is tell a dentist or a work and where do you see it not working in your profession of orthodontics

Christian Kenworthy: this is actually this is a great tell a dentistry model so I have patients who leave Montana to go to college want braces done will work them up figure out a treatment plan build them aligners and send them with liners and there's a there's a great product called dental monitoring that will let them down the pictures into an app through their iPhone and it will update your scan so we will measure how much the teeth are moving so there's a they're great who makes that dental monitoring they were their own company when I bought them they're actually out of Paris so for a while my family I moved my family to Paris and had them living in Paris for about three years and how long ago was that I mean we got five boys what were they all like under the age of six er no my youngest right now is 16 I'm old so this was between 2011 and 2014 this year 2012 and 2015 right in there so my oldest was maybe a junior sophomore junior in high school age youngest was probably 10 and it was fun anyway dental monitoring that's an aside my dental monitoring is it was a French company they're based out of Paris I think it's rocky mountain orthodontics who sells that product right now is who represents them in the US and but you can get if you go to the dental monitoring website you can see what they do and so they have some little calibrated lip stretchers basically that your patient takes a video of themselves with their iPhone and that data there's enough points on those teeth that when you take a 3d scan you submit that scan to dental monitoring and they'll actually show you how those teeth are moving so they'll measure torque they'll measure tip differences the letter bodily movements so you can monitor how your case is going without on line they just send you a report you can look at the graph you can look at their actual teeth you can check hygiene so I mean I have patients who have left here and were treated by me for at least a portion of their treatment in New Jersey California Texas anywhere where there's a college basically so I think this model foreteller dentistry is great the difference is the plan was agreed upon with me in their office like we looked at the x-rays we decided what we were gonna do they were able to see how I was going to move their teeth and the only part of the plan that was taken place outside of my office was actually inserting the retainers every day aligners every two weeks and then I would monitor them every month to every six weeks to check progress and if we needed an adjustment I had their scan in my office I would just make the adjustments at my office so so I think this is a great Teledyne history model it makes it super convenient for patients in fact the reason they developed that in Paris is because traffic in Paris sucks in the number of orthodontists per capita is low and so it was they developed this purely for convenience and but it was so accurate like there were so many things I learned about orthodontics from monitoring my cases digitally that it really helped my practice become more efficient 

Howard:Wow and now I remember 25 percent of our listeners are still in dental school and the rest are all under 30 um so um I know that sounds silly but what is the difference between smiles direct Club treatment and Invisalign you kind of alluded earlier that Invisalign was one product 6500 smiles direct line is less well how'd you explain that to a young kid 

Christian Kenworthy: so the actual product like what you're holding in your hand is probably the same they're just clear liners the difference is in the diagnosis so that's the  biggest difference is in diagnosis because the trailer so all so there's  probably 15 or 20 different aligner companies and then there's software that you can use to make your own aligners so the difference between the companies is they all have their own kind of proprietary software that tells that they have told how to move teeth you know we're gonna move teeth two degrees of torque each tray two tenths of a millimeter bodily movement whatever the dimensions are that they're going to move that's what they choose to move them and so if you buy an Invisalign product the number of trays to get from that person that had the snaggletooth to the person that doesn't have the snaggletooth that number of trays will be different than four smile direct Club then it will be if I do it myself than you will if you do it was clear correct or clarity aligners or whatever and that's because the software programs are all different but the actual product that the patient has that they put in their mouth they're gonna think is the same it's going to be a clear suck down you know vacuform tray that kind of looks like their teeth that's gonna feel tight when they put it in so it's really difficult for patients to see the difference between why am i paying 2500 or 3000 dollars for mine and six or seven thousand dollars for the other it doesn't make sense to them and smile direct Club and there are other smile direct Club is the biggest do-it-yourself a liner company but there's probably ten of those - Amanda yeah and that's why they've got this in right there so it's cheap and people don't understand they're looking at the product they're thinking why would I buy a Toyota from Invisalign for $6,000 when I can get a Toyota from smile direct for $2000 they think it's the same product and it isn't it just looks the same

Howard: the tray itself is a lot of technology I know you're there's dr. ray Stewart the founder of Bay materials as an Zinder a dental I mean there's so so

Christian Kenworthy: the resin is really evolving quickly isn't it there is there are a lot of different trays and their modulus of elasticity and plasticity are all different but they're all kind of in the same ballpark so we even if you took the the crappiest stiffest cheapest train material and the most expensive hi-tech drama tears and you put those in two different people and have them go through a series they would their teeth would be similar at the end it's not going to be as comfortable for one as it is for the other but the finish is going to be similar and so that's why I say if you hold a smile direct clip tray and an Invisalign tray you aren't gonna be able to tell the difference as a consumer or even as a dentist if you're just holding the trays your your you have to know something in the background to know that there's a difference in those trays 

Howard: well I used to remember go back ten years ago when when Dennis you know when orthodontist would most would start really complaining about Invisalign I'd always say well you know quit using them I love their I love their their resonate

Christian Kenworthy: so marketing that's what they love they market for their practice right they love the marking yeah that's why Invisalign becomes addictive for people so I mean if I tell you if I ask you or if we ask your listeners name me three aligner companies in busy line will always be one of them right and if you go to the internet and type in aligners Invisalign is going to be if it's not the top it's because smile direct is the top but they're both putting so much money in the marketing that that's the name you associate and so if you say I want aligners and you Google I want aligners who can give me a liners Invisalign well because they're marketing they'll push people to practices that are doing more Invisalign and so you become addicted to that marketing because you get this patient flow the truth of the matter is it has increased orthodontic awareness for the whole kind of population and so I'll get you know on my days that I see me patients I'll probably get thirty percent of them will say well am i a candidate for Invisalign and because I don't use Invisalign I tell them you you're a candidate for aligners and I just explain I use these aligners instead of Invisalign and nobody cares like nobody-nobody no patient cares but Invisalign does a great job of advertising for all of us really and 

Howard: what they'll do is they'll advertise so they lose it because I'm once the Supreme Court's clear on this I mean once the word becomes a verb it's gone like  when you start saying go Xerox is for me and she walked over to a canon printer you lose your deal right now everybody in your practice has hand me a Kleenex and you hit him at issue so if it so if it becomes just like when you travel the world 220 countries a third of them the word for toothpaste is Colgate there is no toothpaste so they so mama says just go put some Colgate on that it could be one of a million brands my favorite toothbrush fact toothpaste factory is in Philadelphia Pennsylvania I was lecturing there and some guy says oh you're gonna have a tree I got this lined up for anyway it's a company that had the same toothpaste same container but they private labeled it for like several thousand different countries and languages and it was just amazing watching that so Invisalign they gotta be careful if someone says you need to get Invisalign and they that can't understand so basically explained to the kids so basically the patents are gone that's why you're having this plethora of on this Cambrian explosion of clear aligner companies yeah that's true

Christian Kenworthy: the other thing that is changing this is a lot of dentists are getting printers so the reason I don't use Invisalign is because I print my own and the printer technology is getting so fast and so accessible that it almost doesn't make sense the money doesn't make sense for a dentist for an orthodontist anyway so a dentist assume that makes sense because they're not really familiar with how to remove teeth and so using Invisalign software and their staff to move teeth would still help a dentist but for an orthodontist who knows how to move teeth it's it's pretty easy to use software to move teeth and it's relatively cheap to print them at your office significantly cheaper than what you can buy a case for from Invisalign and so that's I was actually lecturing in an Invisalign rep they don't like me very much but they came up and talked to me and that's what they said they're their biggest competition right now isn't from these other companies as much as it is from Dentist who are able to do it themselves  

Howard: so you're um you're a fan of the park dental research let me yeah you're using woody Park Dental right you're a 3d printer the jewel yeah the jewel and from Oklahoma of all places so why do you like that one 

Christian Kenworthy: so I like it because it is fast it's accurate and it's basically like an f-350 like the thing just works so it's I've had others that are more finicky have to be calibrated more often and all of that stuff kind of slows you down so I print the jewel to print six models at a time so I have two of them so I can print twelve models in half an hour with these two printers so if somebody wants you know when if I have a patient today that got their braces off at ten o'clock in the morning I sent him to go get lunch and they come back after lunch and they have retainers or if somebody comes to my office for a new patient exam and we determined that aligners are a good fit for them they can pick their first aligner up tomorrow they're not waiting for a company to produce these aligners we send it to the printer I'll actually send it to the printer from my new patient exam and they'll have a liners tomorrow so they're just I like them because they're reliable the build plate is big enough that you can get you know the build plates like the size of a laptop basically and so that's its footprint it's probably I don't know three  and a half feet tall so you have to have some room in your lab but they're fast the other small ones are slow so they're really accurate they'll print 250 micron accuracy but they'll take 8 hours to print a dental model and so they're great for dentists like this jewel is great for a dentist too but it's really built it's more designed for the orthodontic office in mind some places printing a lot of models so a lot there are cheaper printers and they're great for dental applications you know where you've only got you know if you're gonna take five impressions a day using one of those other printers would be fine you just have to use that to be willing to wait like I didn't want to change my practice efficiency from alginate and fast set stone when I bought printers and so my printers had to match or beat what I was already doing and these do that 

Howard: so I'm so I there's so many things flying through my head so let's go back to Invisalign Joe Rogan's the CEO um he there was a controversial thing where he's selling Invisalign aligned technology also owns I Tarot and so he kind of just wanted to make it so you had to use as a tarot scanner and not other scanners was it was that a good move for him in your mind

Christian Kenworthy: I think that sent a lot of people away from Invisalign there was a lot of guys I mean it scanners are thirty to fifty thousand dollar investment so if you had a scanner that you liked in your office and it was working and a company said you can't use our product unless you buy another scanner so the entry fee now is an extra thirty to forty thousand dollars there's a lot of guys that just kind of flipped him off and so never mind I'll find something else I think that actually helped some of these other companies grow because people were they just kind of were like I'm not paying an extra 40 grand so that I can tell people I use Invisalign and I think they've changed that I think Invisalign will take other scans now like I said I don't use them but I have heard from guys that I think they kind of changed their mind

Howard:  yeah it's just they're just so agree I don't know it's my Kansas upbringing or what but I just always see people doing things and like it's just like blows my mind out I do so you're um you know do you when you see general dentists doing Invisalign in Montana and Adana sees general disaster in a mall window when her oral surgeon sees a general does take out her wisdom teeth um what do you think of when you see your general dentist family physician colleagues doing Invisalign

Christian Kenworthy: so I don't actually mind general dentists do Invisalign and the reason is it there are some cases that Invisalign can't treat that a general dentist is doing Invisalign is a general dentist who is looking for orthodontic needs right where some of them don't because they're it's just not the focus of their practice so if and this line becomes part of your practice as a general dentist you're gonna start seeing things that that could be improved with orthodontics more than somebody that's not looking for that and there's enough cases out there that if if the general dentist is doing the easy ones and he's sending me the hard ones I'm fine with that the the real thing I think that happens is at a certain point you're going to get a case that you're going to do with the biz line that's not going to turn out and somebody's gonna have to fix it and so I I'm happy to fix Invisalign cases from general dentists and I generally don't charge for them because it helps me teach the dentist like what the limits are of that technology versus braces traditional braces and so it I don't mind it that's my short answer

Howard:  do you think Joe Rogan is underpaid though I mean they his salary it's only 41 million a year that is kind of light and do you think that is abuse somewhere so um so you so succinctly why do you not do Invisalign

Christian Kenworthy: I don't do Invisalign because I believe that I am a better orthodontist than the computer technicians at Invisalign 

Howard: nice ok so let's go the it monitors I loved your quote on it's called orchestrate orchestrate 3d you said up yours truly says I love the ability gives me to control everything in the aligner process I've been using orchestrate 3d software and they're in office printer since 2014 their systems allow me to do all my retainers and aligners in the office the retainers and aligners we produce are always dead-on actor and fast and doctor taller than their sir Seymour second down blah blah so um so here you do are you using your own software in printer do you think it's more so that you can get it back faster time is it more because it's lower cost is it more because you're more in control and you're designing and doing it woods what's the most waited and least waited in that

Christian Kenworthy: I think control is the most week the highest weighted factor so if you've ever done an Invisalign case you are familiar with the term revision and that's because that's inherent in the software if you don't control it I don't ever do revisions because you're using that it's just another tool it's just like bending a wire deciding where to place a bracket I don't do revisions yeah I don't think a lot of kids know what a revision is ok sorry so what happens is if you setup if you send to a software company and you have them make your liners they're gonna say this case can be treated in 22 aligners and you can change them every two weeks and so you have a conversation with the patient that says hey guess what we got this case back and it says we can treat it in 22 aligners they change every two weeks so this is a 40 for a week forty four week case so I'm gonna give you you know five or six lines at a time we're gonna check progress but when we get to this number 22 Morgan everybody has the same expectation that we're gonna be done well you get 22 and because of the the inherent properties of thermoplastic materials there is some slop in that system and so when that slop is magnified by 22 trays you're not done at tray 22 and so what you do is you rescan that patient you send it back to there's a line and you do a revision and those revisions can be 14 or 15 trays I mean they give me a lot of trays because you're catching up for the slop in the system so what it does is it makes you feel like an idiot unless you've explained that to the patient before the patient is disappointed because they thought they were going to be done at trade 22 and now they've got 14 more trays so there's just a lot of conversations that need to be had that's what a revision is so when you understand the principles of thermoplastic materials and how to how to correct for the weaknesses of that material you can avoid doing revisions and so you can finish when you tell your patient that you're gonna finish so the control is my favorite part but it's significantly less expensive what was the third option I had so um so this

Howard: so you like orchestrate and that that's by another orthodontist that's taught earlier right yep so tell me and tell me what taught earlier is doing and why do you like orchestrate and Todd earlier on company 

Christian Kenworthy: so orchestrate is a a software that takes a scan and creates an individual file for each tooth within that skin okay so so if you just take a scan and you want to make a retainer you can go straight from a scanner to your printer and print that model but if you want to move the teeth you have to be able to make each of those teeth an individual file so you can move them so this software orchestrate 3d the other one I use is called you lab he wants to look up you lab those are the two software's that I used right now both of them do this so they generate a 3d object for each tooth that has a gyroscope in it that allows you to move that tooth in six different planes and so you can take those teeth and move them individually to where they need to be and then the computer will measure how far that tooth has moved in all those dimensions so it'll tell you this tooth moved you know a millimeter distal and torques 17 millimeters and rotated 22 millimeters whatever the whatever measurements you've done to it and then you get to decide as the orthodontist how many trays it's going to take to get that tooth to move those 33 degrees or whatever the millimetric difference is and so in so that's what I meant earlier when I was talking about the differences between these software programs so Invisalign might take that movement and their software is gonna say this is gonna take 22 Trey's smile direct clip software might say this is gonna take 28 trays you might look at it and say this is going to take 12 trays whatever the number is based on your experience and that experience is based on with with companies like Invisalign or smile direct so they're taking and kind of a industry average of what those movements should be and just putting them on those teeth so if you've ever moved teeth in a real life with even with the liners but with braces you know that different teeth have different root structures they move differently it's different movements are harder for different teeth and so you're controlling that with an orchestrate 3d or a you laughs you you get to decide which teeth are gonna move when which direction how are they going to get out of the way of each other all of those decisions you make because you're an orthodontist so the end goal like if you tell do you look at an Invisalign you know the cartoon of what it's look like those teeth are gonna look straight in a line if you look at an orchestrate case that I've done at the end those teeth are gonna look straight in the line the difference is how we got there and that's what determines how efficient the systems

Howard:  so you mentioned you mentioned you lab yeah you mentioned you lab and they're in the news because they orthodontic aligners software you lab systems announces partnership with bae materials the maker of xander a clear liners and retainer materials what did you think of that announcement when you found out that you lab is partnering with bae materials to make curves in dura clear aligners what does that mean to you 

Christian Kenworthy: I don't know exactly what that means I'm wondering if they're going to start printing trays for their customers so I use them only as to generate STL models so that I can print them but there may be other functions within that program that I don't use that allow allow you to send that STL file to them if you don't have a printer and maybe they'll print it and give you sender aligners I'm not sure what that partners you know that you love founders charlie win in a mirror of both faith 

Christian Kenworthy: I have met them or the orthodontist or knows their software guys okay their software guys yep so this is

Howard: mostly a software planning company yes for the scanning yeah they also have a really cool thing that they haven't brought to market yet but 

Christian Kenworthy: I've seen some of the trade shows where they have a machine that will trim so all of these models right now are all made by vacuforming so you take the sender and you vacuform that over your 3d printed model well then somebody has to cut that and get rid of the excess and polish it up and turn it into a retainer that somebody put in their mouth a new lab has a product that will set that model on a tray and they have a little laser that goes around and cuts your tray for you so that you don't have to do that and that's I know that's coming but that's pretty cool I

Howard:  I love anyway I love is a LinkedIn page founder no more updates God brought me to this world to give me a brain to invent stuff to benefit people I'm never afraid to try in various industries nothing satisfies me mordin to make people give big smile but the reason I was asking is I'm about these two guys do you see whichever base Your Honor I don't know if you're on first base run to second is the next big thing in your profession is AI combining AI mean your digitally scanning your digitally printing do you think these guys are looking at something I a I based where there is AI actually in the you lab software 

Christian Kenworthy: so the you lab software learns so I don't know if you've ever done attachments but somebody in your audience is going to have done it and there's explain explaining them what that means so clearly a versatile they're still in dental kindergarten alright so when you if especially if you use Invisalign there will be attachments which are little composite squares triangles pyramids half circles there will be a little a little composite bunk on the teeth that the aligner can grab onto and the reason that those attachments are there is because the aligners are inherently sloppy especially after a liner 12 or 13 but the attachments never changed the teeth can move but the attachments never change and so the attachment gives that a liner and the software engineer something that they can depend on so that's what an attachment is so for example I don't use very many attachments because of the way I designed my cases and the software and you lab for your first case it's going to assume that you're coming from an Invisalign type background so you'll bring a case up and tell it kind of where you want to move these teeth and it will automatically generate attachments that has been programmed to put for certain movements of teeth and so you'll get attachments on different places all over the teeth and then you have the option to take those attachments off and so the first time you do that you take a bunch of attachments off and the next time you get a case it puts up maybe three-quarters of the number attachments like it's still saying hey guess what we are software says you're supposed to have an attachment if you do this movement and you delete that attachment and after a couple of times of doing that and I don't know the number but it starts to learn oh Ken really doesn't like attachments so now when I do my cases it doesn't give me any attachments any attachment that I put on there I have to place on the tooth because it's so there's some AI built in that software which is kind of fun to watch so and it's based on my user profile so you went on and said I'm gonna do a you lab case it knows that you're not Christian Kenworthy and so it's going to throw a bunch of attachments a because it's going to assume you're coming from that background and until you tell it I don't want attachments it's gonna keep putting them on because that's what it's programmed to do so 

Howard: so do you think with artificial intelligence that you know with big data that that more like if you send you to your first impression they don't really know who ken is but after you send in ten they know you more I had a hundred they scale you more at a South do you think it's one of those deals were if you keep going digital big data AI that the quality goes up as the big as a data set gets bigger 

Christian Kenworthy: I think that your average quality yes will go up the problem is nobody's really average right and so because orthodontics is so custom using that average I think is great to get started but what I like about both you lab and orchestrate and orchestrate has an AI function to where it'll  tell you the number of trays it thinks you should use and  it can do an auto alignment thing those  are great they're great to show to patients so I use these technologies in my new patient exam so every patient that comes to see me is scanned before I see them as a new patient and there's their STL map is on my computer when I sit down to talk with them so I can move teeth while we're talking to them and give them an idea of what we're trying to do with our orthodontics so those things are all great the reality is we're all custom we're all individuals and so there needs to be some modifications in both of these programs orchestrated and youlab allow the user to tweak it so you can say give me your best shot and it'll kind of give you an alignment and then you can tweak it and make it right or do the over Corrections that need to be done to compensate for the vacuform material which is really cool because it allows you to use the AI and still make it perfect 

Howard: I asked my girlfriend if I was the only one she'd ever been with and she replied yes the rest were all nines and tens nobodies average that was a that was an average joke um the one the one thing our listeners don't like is when people don't pick one or the other you like to in office aligners you like orchestrate and you like you know Baima toriel's makers endure with a partnership with you lab because they  always they're they're cynical they know a lot of people are selling stuff so they're always gonna say well if you could only buy one which one would you buy so narrow that two to one

Christian Kenworthy: so you're talking about orthodontic movement software's what you're asking me right now and those softwares are different there's it is simpler to use you lab for someone who is just starting out it's faster to get from scan to model the pricing structure of you lab is based on the number of STL files you generate and so right now I'm probably spending five $600 a month on you lab orchestrate is a software program that you buy and then it is yours so it's free to use until you decide to update it and so and then updates costs whatever they cost depending on the upgrade got great amount so for someone who is starting out I would say so orchestrate has partnered with Park dental and so orchestrate will sell you the software the computer necessary to run it and a printer so you can be besides a scanner you can be ready to print your own models with that orchestrates software when you buy it you have every piece the new lab is just the software and so you still have to buy a printer from someone else and have that person comes that your printer up and calibrate it and so the you know those two things have to talk to each other and having them in one company having orchestrate be your software person and your printer person if there's ever a problem you just call orchestrate because sometimes you don't know where the problem is did this not print right because my printer is there's wonky or I didn't set it up right or did this not print right because I did something wrong in the software and as you know as everybody knows there's nothing more frustrating than calling a service company and saying hey I'm having this problem and they say oh it's not our problem it's that's the printer you need to call the other guys and you call the printer and they say well we checked we checked the printer it looks good you need to talk to your software company and you want to just say here you talk to this guy and figure it out and so the benefit of using orchestrate is it's a all-in-one package and so there is nobody else to call they just make it work and they do a great job of making it work 

Howard: okay so then is that what you call that when they work real well together is that an open system or a closed system 

Christian Kenworthy: so it is still open so like I use you lab and I still print it on the printer that orchestrates set up for me okay but somebody had to come set that printer room and I'm actually my second on all of my printers I bought through orchestrate and orchestrate kind of beast the printers up a little bit they make sure they're ready to get calibrated they make sure that all the parts are are beefed up because they know orthodontists are going to use on ten thousand times a years and so but it is still an open system orchestrate does not care where you get the scan from and they don't care what printer you go to so you could just buy the orchestrate if you already had a printer you could buy the orchestrate software send it to that printer if you already have a printer or if you already have the you lab software you lab doesn't care what printer you're using either so all of these are open system the only the only nice thing about the orchestrate is because they've sold and delivered you the printer and the software there is no when something doesn't work you just call one place and then are you calling them a lot I mean even let's just laugh at the office printer most people will not buy an office printer because it breaks down so much zebra they're just getting a maintenance plan yeah I mean printers just no tourists they don't work ya know it's just when they're getting set up there's a bunch of moving pieces and so the learning curve is about this steep once you get there it is beautiful but that learning curve is really steep and so trying to put all those pieces together yourself is going to be a two weekend project where you're spending eighteen hours a weekend at the office making sure that you know when you tell a tooth to print that's seven point six millimeters wide and that's what it says on your computer when you print that tooth and you measure it with your caliper it's really seven point six millimeters wide and so those things are things and so it's really just at the beginning after that the printers just run we had to update one of our computers on one of our jewel printers about three weeks ago because they're everything's going to Windows 10 you know they're not supporting than Windows seven and we had to change a computer out on it and that was all done over the phone so we just called the guys down at Park Dental and they walked through over the phone with us how to get the new computer of death with the printer and you had to work through a couple bugs because I had recalibrated so took a day our printer was down for about a day running some tests and then it's been back up yeah

Howard:  so um in all honesty if you will just say that you made an online C course for dental town on how you do all this what would the orthodontist on ortho town cuz weirdo town you can't join or throw down unless you're an orthodontist I mean I own the site I can't go on it I own the magazine I've never had an article and that's cool I mean I remember in Arizona that it had an all-boys Golf Course first I knew like five dentists that were members there and there were so many people outraged by that and it's like freedom an if you're five guys and you want to have it what was it called on the little rascals the yeah yeah they all boy you know whatever hey so it was totally cool um in fact the biggest fastest growing thing on dental town is private groups were you can set up your own private group and no no but you're the one that can let people in or out and no one else can see what soon because the problem with Facebook so much is you there's no anonymity you can't go ask a stupid question on Facebook when everybody sees your profile but anyway is there still kind of bad blood on that where if you were showing general dentists how to do that on an online course in on dental town would some of your specialists look at you like you're a traitor or something like that or is it all like that so maybe like 

Christian Kenworthy: the problem is how are you gonna teach they would you're basically so teaching someone how to print models and make sucked down retainers I think is general knowledge the the part that would be hard or weird to teach is how to know how to move the teeth in a computer system that because that's like all of your experience from your ortho residency in practice in orthodontics so generally I don't I don't teach that part really even when I lecture because is just orthodontics what I'm teaching is I teach Orthodox out of ply the stuff they already know to this digital world and so you know teaching somebody or explain to someone hey this is a good printer and this is how you hook it up and this is why you'd use it is easy but like you would you didn't you'd have to do it orthodoxy to teach people this is this is how you move this tooth because you're doing it because you need it we need the route to follow and all that you know what 

Howard: I'm saying yeah I don't want to talk about anything that everybody agrees on I like to talk about all the stuff that makes everybody mad and I'm just going on my 32 years experience just in my back door there's also turf feuds between I mean there are open open bashing pediatric dentists who do the class one interventions those guys are punks yeah so talk about that what do you so talk to those young pediatric dentists what what is the macroeconomic debate between pediatric dentists North Moss

Christian Kenworthy: so I think the same way I was telling you about Denison doing busy life and I know there's a lot of horses badges and ruffles that feathered it just pisses them off what the general dentistry on Invisalign yeah and so and the same thing will happen with Peter dentists doing orthodontics so Pete Adonis that see case in a cross bite and they put a an army in an army an army or a rapid maxillary expander okay if they're putting something in that is like a phase one we're just trying to get the bite right or we need to take a tooth out here or we're gonna put an expander or whatever I think those guys are doing a great service to their patients and to the orthodontist the times when pediatric dentists get in trouble or when they do that and then they say well this guy's already my patient I'm gonna do braces on him too when they haven't been trained to do braces it's the same thing as it's not as bad a smile direct Club because they're at least a dentist I mean they understand gum health and they've looked at an x-ray but I mean I haven't done an endo for 20 years I graduated in 1997 so it's been hundred 20 years if somebody said if I said hey this kids developing pulpitis he doesn't need to go to his general dentists I'm just gonna do this endo it would suck for the kid because I'm not good at doing endows and so that's where I think it's a problem um I understand the economic argument for a pita dentist to do orthodontics but I still think maybe I'm old school I still think having the right guy do the job is still the right thing to do

Howard:  so succinctly summarize that again with that pediatric you don't care if they do a rapid Palo expander they're in there a six or seven they see a cross by they

Christian Kenworthy: do that that's not the issue the issue for you is more at twelve thirteen fourteen coming in for final braces right if they're because it's easy if you've got one appliance and it's a rapid maxillary expander and you've got one appliance for a lower arch which is a knee arch and those are the two hammers that you have in your toolbox and you can see where that hammer is needed then do it but what the problem becomes when you start saying well braces are easy because I did this rapid maxillary expansion it worked out super well I'm gonna do the braces next then you start doing everything you just end up as long as you're not doing crappy work do it if you've been trained to do it and you feel confident then do it but don't do it just for money that's how I would sum it up 

Howard: speaking of that when you said that when someone has a pulpitis you're not gonna do the endo you're gonna send them to someone else to do it it's kind of made me instantly think of the orthodontist been Burris you've gotten all kinds of controversy because he decided he was gonna have Hyde's gonna start doing cleanings yeah and he was the most guy we've had him on so he was the most controversy guy I've ever had on the show if orthodontist and now that he's indicted him for fraud did you hear about that and what were your thoughts on that I didn't know I never really knew been like I he was I guess he was too fringed for me so I never went to the meetings that he was running I was interested to follow what he was doing and I think an orthodontists having a hygienist doesn't hurt anybody it just helps the patient's like man that was like it probably it probably been easier if we just start selling drugs out of his office I mean I got Arkansas because my sister Kelly lives in that Fort Smith and my god I first asked is it does he have hygienists like drinking beer whether what is the deal but there was just an explosion what do you think what why do you think everybody was so upset that he had hygienists cleaning people's teeth

Christian Kenworthy: I think they were upset because of the same reason that most people perceive that orthodontists are upset about pediatric dentists taken their money like hygiene and in your office how many chairs do you have that are dentist chairs versus how many chairs you have their hygiene chairs to hygiene six dentists okay so you're running hygiene chairs a lot right I mean hygiene is a part of your practice it's a part of your income that you count on so I North honest my the guys that refer to me are all my buddies I ski with them I hike with them we surf with them we have birthday parties with them like I don't want to take the money away from their practice and that's why I wouldn't do hygiene but I think that's the same reason that everybody got pissed at Buress because that's if if you know if you're a dentist that has three hygiene chairs and you're a solo practitioner you've got three hygiene chairs and one or two dentist chairs those hygiene chairs are going all the time and some of those cases of hygiene are orthodontic cases they're kids with braces on and so those kids with braces you don't see them for three years that's that much money that much income that hasn't come to your practice because a hygienists working in an orthodontist office or hygienists working in dental office isn't doing any worse hygiene it's just an economic question

Howard:  by the way the most controversial thing you've said so far on your show was actually when you slipped and called you you call them pediatric dentists three times but you call them Pete Adonis once oh my god that's a good way to get smacked they uh yeah you know they just don't want it they don't be associated with PTO's you know I'm not gonna let I didn't even know there was such thing as a pediatric dentists until I was older but um so you know my professor used to always say to me they says no I don't care if your work is average or below average I just want you to get an A on the diagnosis and treatment plan I'd really get an A on the diagnosis and treatment plan and a C on the work then get the wrong diagnosis and dream plan and then get a a-plus on the work and so what does that make you that it makes me cringe a little bit when I see these um weekend courses for anesthesiology I mean anesthesiology that's years in a hospital where people can die that's not something you learn at the Holiday Inn and the same thing there's a lot of short-term or at those six-month ortho and I'm like it's not and I I'm always sitting there thinking yeah I wouldn't want an anesthesiologist touching me unless that's the only thing that guy has done and and in dentistry I'm always been able to call crap on my own tribe I mean I'm I'm politically incorrect because I'm honest and you can't go in any Hospital in Montana or Arizona and do the anesthesia and do the surgery it's against the law it's a specialty and when you and when I see these malpractice claims when they get to six seven six figures somebody died and it wasn't from choking on a cotton roll so I've never done it I mean I am and and so the same thing when I see like six month smiles or things like that it's like oh my gosh I'd rather you just take ortho courses and learn to diagnose surgery by and never do a case yeah but it's kind of the opposite of sight well it's not you know let's just kind of show you some tricks to jump in and you know what what do you do you agree with that I mean you remember how the phrase went did your professor say I'd really get a a on the diagnosis dream plan and a D on the work then a D all that dream Atlanta a on the work

Christian Kenworthy: I think that's a hundred percent correct and that is the major problem I mean most if not all of the orthodontic malpractice suits that I've seen have been by pediatric dentists most of them but they are it's because they treatment planned it wrong like you can't get to the right answer if you if you're not going the right direction and especially an ortho I mean ortho is long term right we're talking about 18 months sometimes 24 months sometimes if you really treatment plan around that can be four or five years and so the time between when you put the braces on and when you realize that your treatment plan was wrong can be a long time if you don't if you're not familiar doing it all the time right and that's where people get in trouble is they're you know it's it's thinking that you're flying to Hawaii from San Francisco and you look down at the map and you see that Tahiti is in front of you instead of Hawaii that's a that's a lot of gas you burned going the wrong way and that's where guys get in trouble so I agree with you 100% which is also comes back to the same problem with this smile direct clip the treatment plan is based on some guy sitting at a computer looking at alginate taken by a person is not even a dental assistant you know you get a if you got a crappy alginate taking at your office you're not gonna build a crown for that you're gonna tell somebody to retake the alginate how long does it take you to train an assistant to take a good alginate or a good polyvinyl siloxane impression like that's that's a skill it's not something you can send in a box and say just stick your teeth in this and we're gonna make the liners out of it so you get these crappy trays you stick in a software program I know I'm pretty sure they have dentists working the software program but you got some guy working a software who's never talked to the patient they might get an email chief complaint or something and they say this is what I think your teeth should look like what do you think and the patient says well they look way better you know that your snaggletooth case that you show to the beginning yeah just on my snaggletooth fix oh I can fix your snaggletooth here we go and they run with it so it's crappy treatment plans lead to crappy work even if it's an a-plus amalgam if it's on the wrong tooth you still did the wrong thing but you

Howard: you said that most of the malpractice cases you say were actually from pediatric dentist 

Christian Kenworthy: the ones that I've seen yeah I mean I've had people whine about cases from North Adonis but it's it isn't because something was done wrong it's because the patient was unhappy the ones in my specific area that I have seen that have been incorrectly treated have been from pediatric dentists and that's that's just my experience here okay I'm not trying to start a fight I know you're trying to get me to start a fight you know Punk well you know what what

Howard:  I think Dentists do is when they're in front of each other all the smiles and all that stuff kind of we want to get along and then and that's why they like the reason dental town survived Facebook is because it they can be anonymous and ask a dumb question no one wants to go out there and say you know it's like what I'm on Instagram you know it's like you know it's like your prettiest picture but on on dental town it's like okay I woke up this is bad and they asked they can ask dumb questions and that they won't ask in public like like they always want to know so I'm going to ask you the some some more controversial ones um does orthodontics is that a treatment for TMJ some people swear it is some people say it isn't when someone is TMJ and a lot of them so so this would they tell me they they get out of school they become a dentist because their mom is they go back and price their mom and their moms telling them all this stuff like well we got to get these wisdom teeth out now because see how they're impacted and they're growing forward and they're gonna they're gonna make all this anterior stuff crowded and she's sitting there looking at something from you know the the the NIH and she's like okay mom's from Parsons Kansas and the NIH this isn't true and the other thing mom is always saying to her daughter and to the patient is that well you know all the joints my when I straight my arm my elbow determines where my hand is but when I close this joint it has to fit the teeth so you got TMJ because the teeth isn't lined up with the joint and so they're asking me in my school not get it right or so is so succinctly is orthodontic treatment a good idea to solve TMJ cases and by the way when you write into me and say it's not TMJ STM do shut up the patient calls it TM d and I'm talking to the patient and it's the inner darkness to try to change endodontics root canals the endodontic therapy is laughable but anyway is it a treatment option so I think in some cases it is 

Christian Kenworthy: so in my practice if somebody comes in with TMJ so they've got hot joints first I'm going to look at the cone beam of their joints and make sure that the bony structure is correct the second thing is before I diagnose whether their teeth are even involved in that is I usually send them there's a physical therapist in Missoula who's done some specialty training in job joints and I sent him to her and let her see if she can get uncomfortable the third thing I do is I take their teeth out of the equation to see if the jaw joint pain still persists because mainly I don't want to get burned I don't want to say okay we can help you and then not help them and so I will give them I'll make them a little suck down will print in a suck down and I'll put some little bumps on that suck down so that they have no interferences anywhere basically give them fake teeth and tell them to wear that for a couple weeks if the problem goes away and this is not like I'm not trying to do anterior or enter your with guidance or I need this or I need a post I'm not doing gulps I'm just I'm just separating the teeth it's an appliance it takes five minutes to make and it just makes sure that I'm just and what I tell them is I want to make sure that you teeth effect this is so we're gonna pull your teeth apart from each other so they can't hit and you're gonna wear that for two weeks and they come back in two weeks and if they say yeah my jaw joints still hurt then I tell them orthodontics it's not a solution for you because all I can do is move your teeth and so I think there are some cases with cross fights or anterior scissor bites or something like that really deep bites where you can affect how the jaws how free the jaws are to move that you could have an argument that said we might be able to help you with your jaw joints but I think that if orthodontics is a solution for TMJ then so is full mouth reconstruction and I think we would all agree probably that if somebody came in and they had a slower job joint or a jaw joint that make noise when they opened too wide the full mouth reconstruction probably isn't the answer so the other way I used to determine that is I ask people does your job don't hurt when your teeth are together and make noise or does it make noise when your jaws all the way open and if they say it hurts when I do this and their mouths open as wide as they can go then I say well then it really doesn't matter where your teeth are so orthodontist constantly visit the solution if it doesn't hurt when your teeth are touching so I think your answer has to be qualified 

Howard: okay so are you can I ask you a couple more overtime questions I know we went over an hour one of the biggest controversies of your profession is with the oral radiologists who do not like the use of a CBCT you've got it you've you know that they just think it's too much radiation they're saying that I'm that the use of a thyroid collar is non-existent so so my succinct question to you is is CB CT the standard of care in orthodontic radiology is this moving forward gonna be necessary as we go into a digital world with big data the Internet of Things and Python programming or  what are your thoughts on CB CT

Christian Kenworthy: I think the CB CT should be the orthodontics standard like I have used it for four or five years I have a plan mecha that gives 21 microsieverts of radiation which is nothing I mean not nothing but very minimal and less than what I was giving before with my old pano machine so my CB CT gives less radiation in my pan machine so I use it just like a pan except there's a lot of things that are better being able to see impac of teeth and bone amounts of bone in three dimensions is way better the other thing is CB CT does not have a magnification factor so I can send you a copy of my CB CT and you can say oh this is seven and a half millimeters that's enough room for me to place the implant if I send you a pan oh you don't know how far my pan of film was from the head there's a there's a man you can't take a measurement off the pan oh you can only see relative facts so I think that especially in my case CBC T is less radiation and probably orders of magnitude improved diagnosis so if you're gonna tell me like I agree but if we're gonna agree that diagnosis and treatment plan is the most important part then we have to agree that cone beam is the standard of orthodontic treatment 

Howard: so but is a CBC necessary for a routine screening my six-year-old need braces does that automatically means CBC T in my office it does because how am I going to know you use a thyroid color mywhatever it's called the little Cape thing does have a thyroid collar on but otherwise in the past I would have used a pan oh I'm not going to help her diagnose without a panel and the panel was more radiation than the CBC T so in my office it's not a question and I the radiologists kids who I've treated I've asked him this I've said you know I know the olara principle and how do we make sure that we're not like sometimes I need to monitor and PACA tooth is six months too short is nine months too short is a year too short and to a person the radiologists who I'm treating his children I'm treating have told me you take this image you take whenever you need it there's not enough radiation scare in this machine to make me even question whether

Howard:  you need kids the phenomenally successful guy like you I mean you are you're you're all that and a bag of chips and they're like are all these or I mean there's so many companies that sell brackets and and well first of all what percent of your practice is clear aligner versus brackets and wire and 

Christian Kenworthy: clear aligner might be thirty percent 

Howard: so it's only a third thirty percent I would say probably close to that and all the surveys that we've done you know as owners of or Towton everything seems like twenty percent is like the average but it gets like a hundred percent of all the  press it's kind of like when you go to a dental study club it's like our dental meetings they always have the all on four lectures and everybody listening it only does all on none it's like I've done two six all on non dentures but all the courses that are on bad I mean who would have a denture on all or none it's not sexy enough but or brackets brackets brackets or do you think these different first of all how many different bracket systems do you think there are and how many do you need to see all your patients one one so yeah and what and what exactly is that one they always want to know what do you use what is your bracket 

Christian Kenworthy: I use clarity flash free brackets from 3m so they're all porcelain so every solution in my office is invisible but the reason I chose that bracket is because there's no flash so the 3m people have figured out a way to make a bracket that's pre coated with glue that when you push on to the two that doesn't make any flash or on the bracket so there's no cleanup and there's no risk of flash that can collect bacteria so the reason I use them is not only are they they're a beautiful bracket they're clear but there is no flash and so it's faster to put them on remember I'm an efficiency guy so then it's one less step to put them on and my risk of decalcification and carries around the brackets is less that's what I said that's the only facial bracket that I use I use what's called incognito which is a lingual bracket so you can get clear facial brackets you can get lingual brackets or you can get a liners in my office you also

Howard:  I swear this is the last quiz it's the last of the last of the last question you also talked a lot about custom bonding jigs and the surf technique what they my homies don't know what either those are what is custom bonding jigs and the surf technique 

Christian Kenworthy: so custom bonding jigs are I will scan a patient before we start braces and put that into my software either that orchestrate and usually for jigs I'm using orchestrate pretty exclusively I will line the teeth up so I'll correct any occlusal cants I'll correct all of everything and then I will place digital brackets in that set up and then I will print that model with digital brackets on the model and then I'll make a suck down tray with where the and so before I couldn't that model sorry I skipped a step before I print that model I let the malocclusion return so I just tell the computer never mind about the fix that I did go back to where the teeth are crooked and so the teeth will go back to where they are in the patient right now but the brackets that I placed when the teeth were straight are still in the same position so it's told me where to put the brackets if I want to not put any bends in my wire and then I print that model I make a suck down tray and we cut the little window out where the brackets would be you place that on their teeth like you would in a liner tray or any other kind of retainer and there's a hole in the model where the bracket goes so the other reason I use flash free brackets is because otherwise the brackets would stick to the material and so you just put those brackets where the hole is in that retainer and because you've already done the setup you can let the nickel titanium technology bring those teeth to where they're supposed to be without thinking about it so it allows the teeth align quicker but you also don't have to see the patients as often so you can I can go 12 or 16 weeks between visits because I know the brackets are in the right place as long as the patient doesn't break a bracket off those teeth are going to end up where I want them to go so surf technology is something that I teach something that I've invented it's called that stands for setup for rapid finish and that's where I use this jig so it's like just like you said it's all about the treatment planning the diagnosis so we diagnose and treatment plan that case build a digital finish so before they get their brackets put on we've already finished their case we know where it's gonna end up so surf is set up for rapid finish  

Howard: finishing is the whole game is I don't do you think finishing do you think it's diagnosing finishing or retention 

Christian Kenworthy: retention has way too many variables you can't control retention and so I think your diagnosis and your finishing setup your retention but what it allows us to do you know you say to me so let's say a patient comes in and like all patients they don't want to wear braces for very long some of those patients will think I only want aligners well some cases can't be treated with the liners and so we'll use this surf technique where we will we'll set them up in the computer where we know they're going to end we build brackets to that position we put those brackets on and we let him cook and for an adult like let's say you're getting married next summer and you come to me now which always happens in orthodontics they think oh yeah I'm getting married next summer I want to have straight teeth and they come see you in October and you think to yourself there's no way in heck I can get you done by next June and the truth is you can you can get them to a position where you can finish them in a liners really easily and so surf technique does this this bracket bonding jig that gets the teeth in the right place we work through wires for about six months and then we take the braces off and build aligners to finish so we do the finishing in the in that specific case we would do the finishing in aligners after we've got all the kind of heavy lifting done with the braces but it's all set up from the first day 

Howard: well I mean I just thought I was so excited to have you on the show I loved your article in ortho town when I googled your name I mean you are a rock star I know you're humble guy in Montana and all that stuff but you are a rock star and it was just an honor that after a really long hard day you decided to set a hangout with your five boys and eat cupcakes too come on dentistry uncensored and talk to my homies and I just really deeply appreciate it thank you so much for coming on the show today you are welcome thanks for having me this is really fun 

Category: Orthodontics
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