Dentistry Uncensored with Howard Farran

How to perform dentistry faster, easier, higher in quality and lower in cost. Subscribe to the podcast: https://podcasts.apple.com/us/podcast/dentistry-uncensored-with-howard-farran/id916907356

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Howard: It's just a huge honor for me today to be podcasting interviewing Christian Brutzer who became president of Ivoclar Vivadent North America taking over as longtime president Robert Ganley retired. Richard is also the global head for Ivoclar Vivadent an asia-pacific region and a member of Ivoclar Vivadent AG Lichtenstein's corporate management board. He will maintain in those positions, he's a lawyer by education he was born in Germany furthered his experience during a postgraduate program in Japan he has been in the dental industry since 1989 serving in various executive management positions in Europe Southeast Asia China Japan Australia USA. He speaks multiple languages including German English and Japanese. Christian joined Ivoclar in 2006 as Director of Sales asia-pacific in July of 2011 he became a member of the organization's corporate management team his tenure leading the asia-pacific market for Ivoclar he oversaw the establishment of subsidiaries in Japan China India and new representative offices in Korea and Indonesia he led his team in building Ivoclar Vivadent presence in mainland China from a representative office to one of the leading international dental companies in the Chinese market. He has also helped maintain strong market positions over the years in Australia New Zealand as North American president Reuter said that Ivoclar Vivadent would remain committed to developing solutions for quality aesthetic dentistry he quotes "We are also committed to providing world-class education and training for our customers" in addition he is dedicated Ivoclar's mission to bring technology solutions and the most innovative products to the market so that both dental professionals and patients can enjoy meaningful advances to oral health by continued to have improved results. My gosh the story on Ivoclar I mean it's been going strong since 1923 it's headquartered in Liechtenstein which I think has got to be one of the coolest countries in the world not a lot of people there is only what three hundred thousand people.

Christian: N no no in tens of that 33,000 people 35,000 jobs you can't imagine we rush-hour traffic.

Howard: Oh my god but it is so it reminds me of Tokyo everything works everything's on time everything's clean everything's functional and they have beer almost every other intersection.

Christian: We have two breweries believe it or not.

Howard: So I want to start off with a macro so the people listening to podcasts they're all young they're under 30 and a quarter of our listeners are still in school and the rest are all under 30 and sometimes they always wonder if you know they're getting out of dental school nowI got out 32 years agoI got out in 87 you started dentistry 89 so what's our off macro, how's dentistry changed in the three decades you've been playing in it?

Christian:  first of all, thank you for inviting me to the podcast and giving me the chance to connect with the Townies I mean this is a great community that you created over the years that I greatly admire and to your question what has changed, I think when I when I came into dentistry communication was a challenge right you went to Asia and you were basically incommunicado with said office right the people in Asia had hard time to connect with their colleagues in the States yeah they connect with the people in Europe and really conventions international conventions where the means of exchange and today we are talking about the podcast right now and most probably their young followers of dentaltown that are sitting lifetime in Tokyo in Berlin and in New York and instantly have access to this information this is the most dramatic change in our world of Dentistry that instant access to information.

Howard: I think when John you know are we humans watched silent movies while they had photographs for 40 years before somebody put those together what was even worse is how long chocolate and peanut butter were separate before someone figured that and I think when Steve Jobs plug the internet into the phone in 2007 I think the century starting in 2007 will be humanity's greatest century because of what you said perfect information is almost zero cost so when you get the planet we see eight billion people how many dentists do you think are in that I am eight billion?

Christian: I would think that the number is varying largely due to the fact that we have numbers of dentists that are qualified to practice dentistry but they don't practice dentistry so I would say the the realistic number is anywhere north of two million.

Howard: Right that's what all the smart people are saying and a lot of people say well this person only had a two-year degree a three-year degree a five-year degree it doesn't matter I think a dentist is someone who works full-time in the mouth so if you're if you need a flipper and this is the guy who does it in your village he's a dentist. So there's eight and billion people to million dentist I want I want to start with a with the my view of the last 30 years in relationship with Ivoclar which I think to you young kids who weren't around in the 80s Bob Ganley single-handedly started this whole cosmetic revolution he got the hottest cosmetic dentists and he to tell him what they wanted and needed and he worked with them and I mean I when I got out of school the it was a full gold crown and an amalgam and the new boy on the block was a porcelain fused to metal crown and here is the thirty years later nobody wants an amalgam nobody wants a full gold crown even though I have seven of them in my mouth and and now it's all a beauty and I credit that to your billion-dollar company you created a genre of cosmetic dentistry and nobody did it no no you guys led the way I mean do you agree with that?

Christian: I feel honored that you see it this way we pride ourselves that really that was what teak star, especially in the United States we answer the need of patience and I always I always tell my friends in the industry you know when you do before-and-after shots cover the mouth don't fix yourself on the teeth look at the eyes and you will say we will see the life-changing life-changing event that anesthetic smile creates in confidence and in self-esteem and that is really what this aesthetic revolution brought to dentistry and created for our patients the outcome is fantastic.

Howard: and of course whenever you know in engineering terms you're trained that everything is a trade-off if you went to car to be lighter to get more miles to the gallon you know you might have to move from metals to plastics. I always thought the biggest trade-off of the aesthetic revolution was you had this amalgam and the mouth as you know 600 species of bacteria trying to eat everything and when the amalgam was half mercury and the other half was silver like silver diamine fluoride tin like stannis fluoride I mean everything in that amalgam was anti bacterial it was just ugly and do you think a composite will ever be antibacterial like an amalgam was and still is?

Christian: It's a very very very interesting question you put that forward there Howard see this is something that that really really greatly invigorated my daily life I've been I've been the president of the international dental Manufacturers Association as you know and during my tenure the Minamata convention became very very active and the banning of mercury in the environment became a very hot topic and as a collateral impact mercury an amalgam was targeted we worked very closely and I was very involved with the FBI on a global basis to give feedback to the UN and to the Minamata convention members that eliminating amalgam overnight would leave a lot of people in the world not in the developed world but in Africa and Asia without a treatment option the only treatment option for dentists practicing there then would be extraction. So we promised in a meeting at King's College that was organized by ADR that we would look into alternative materials and we took this very serious at five o'clock our owners had visited just before India and we talked with a lot of Indian dentists on that trip and they told us Christian you need to do something that gives us an alternative maybe not immediately a replacement of amalgam but a true alternative and we went to work and we launched two years to now have years ago a product called Cention it's a new alka side material that is in powder liquid form so what was the idea behind was we wanted the effects that you just described for amalgam combined with the with at least the aesthetics of glass ionomer cement and the handling abilities of glass ionomer cement with a perfection and a performance that would allow us to be about 100 megaPascal of compressive strength so that we could go into class two situations, Cention does that it is charged with a new filler that actually controls the gap it can be done retentively just with an invention or retentive preparation that some of us still remember how it was done for amalgam but you can also work with an adhesive and then itself cures with the adhesive.

Howard: So on your website if they went ah Ivoclarvivadent.us where would they go to find this product?

Christian: You would have to go for the time being you would have to go to them to the head office ivoclarvivadent.com and you type in Cention and that's the product and we are in the process we have gotten 510 K clearance.

Howard: How do you spell the product?

Christian: Cention from centum 400 and I on for iron release.

Howard: Okay okay that makes sense.

Christian: So it's a process of powder liquid at this stage because most of the markets at the carnies surfaces product powder liquid markets where you hand mix and it's been around in India it's been used in Africa it's been used in Southeast Asia unfortunately you know in China it's because it is a revolutionary new material we have to go through a very very lengthy and burdensome and expensive regulatory process in China so we are still at least two years out to release it in China it's a shame but it is what it is.

Howard: So do you think that's a good checks and balance system where governments check some balance with business to get a better product or do you see it as a burden that really slows down development?

Chirstian: No I think I think frankly speaking it is is it is an alternative for countries and governments that are concerned about the use of amalgam and want to go amalgam free but have for example problems with humidity have problems with heat have problems with electricity so like acute materials don't lend themselves as an alternative it's you know.

Howard: I mean yeah and when you hear people say that amalgam should be banned I mean it's like do you not know there's seven and a half billion people on earth and just to have a rubber Dam and high-speed suction and an isolate that's not gonna happen on at least what 2 billion people.

Chistian: I think you know as much as all care for the for the environment and we should not be too pooling their arguments like we also have to have an eye on the on the human being and and the impact bet oral health has on people and human beings in these areas it's very nice when you sit in the office as I do although there's snow outside he in Amherst New York Buffalo you know we got the snowstorm of the season yesterday and you think about okay I can go to my dentist next door and he has access to to everything you know from Emaxs to tetra key verse around whatever is thrown at him he has a solution right but if you are if I have my life before I came to the states in 1997 was mainly in the developing world. I did a Latin America I did Asia Pacific I was in China yeah the first time in 1987 after the opening you know and I have seen I have seen in every kind Asia in India you know oral health and to take away amalgam is taking away restorative options right you leave these people and interest and and you don't have enough technicians to do dentures so what's the what's the option for these folks don't we have a responsibility there to it that goes further than a commercial responsibility though we have a social corporate social responsibility to make something available that is a true alternative.

Howard: Hey I want to I think this would be a great time and are you during the snow or you don't like it, you like it?

Christian: Look I was joking, I left Germany I grew up in northern Germany I left northern Germany because I was fed up with it and migrated to Australia and then I when I was scheduled to come to the States the first time I was due to go to California but ended up in Eastern on the East Coast and in New York area so do I enjoy it well well

Howard: Does it make it hard to recruit I noticed when I talked to Rick workman who owns almost a thousand dental offices there in Effingham he's always told me one of the biggest challenges of Heartland is when you're headquarters in a town of 10,000 yeah it's hard to recruit management name is it is it a recruiting factor to get the best people to move to Buffalo I mean what do you do just keep telling them that the bills are six and three the bills are six and three the bills are six and three?

Christian: First of all I think I mean we have we have a great local dental school right so we have we have a great talent pool right here right down the road from us 15 minutes drive number two you know if you talk to some of our staff you they will tell you they really enjoy the seasons and so I guess you know there is there is a lid for every pot you know.

Howard: Yeah I know when I was growing up in Wichita Pizza Hut lost all their friends and family because they moved their headquarters to Dallas because they said they couldn't recruit the senior management they need it in and then remember the Gateway computers in South Dakota moved to San Diego, so it's always toughen to do that hey since we have so many kids listening right now um this would be the best time man if you want to say anything about your apps you got some neat app she got the Ivoclar event app you got the IPS Emaxs shade navigation app IT just smile app the program an app only in combination with the furnace is there anything you want to tell i'm cuz we're talking to all the app users.

Christian: Yeah I mean obviously with giggle joining us and diego you know who was the product manager behind as you know very well the observed gate right then left us and went to Silicon Valley and worked in the technology industry for quite some time.

Howard: Who is this?

Christian: Diego is our new CEO

Howard: Oh

Christian: Yeah and Diego Gabathuler brings a complete fresh set of eyes to us and actually it drives us into even a more awareness of an app oriented world.

Howard: So you're saying Diego Gabathuler?

Christian: Yeah

Howard: He's behind these app developments in Silicon Valley?

Christian: He is pushing it even further and he came he came to us with a strong understanding of app because that was his background in the Silicon Valley we had already some apps but we actually had acquired a company that was a start-up in Zurich called company and they have unique insights into animation and virtual reality we brought that together with our digitalized the tooth library and we created the Ivosmile and I really recommend you to your townies to go into Play Store or the Apple Store and to load down the free of charge Ivosmile at and play with it and you will see it's a different way of communicating with your patients and then there is of course a commercial version of that for for dentists and we strongly believe that this will be one of the most important tools in the future of convincing and showing treatment plans and outcome projections to patients it's a real cool tool it's a real cool tool and it play with it.

Howard: Yeah and I just want to remind all the kids out there this is not a commercial there's no money changing hands I've known this gentleman for a long time and I just think it's an honor that he came on the show to talk to all you guys on your commute into work. So you know when I think of Ivoclar I really think I basically think of three areas which you dominate direct restorative materials, fix prosthetics and removable prosthetics is that still your three main pillars of your strength?

Christian: That's still the three strong pillars with a force with growing strongly over the last two and a half years, which is our digital equipment and digital solution pillar. We've gone with the acquisition of Leland some years ago into the digital field our cooperation with DENTSPLY Sirona obviously is still strong we still supply into the CERAC system the majority of the blocks but we also developed our own solutions and own workflows for labs and soon also we had in the process actually of the job of mounting our first well empty aside machine the program l1.

Howard: Well let's talk about that as so gosh when I got out of dental school in 1987 the CAD/CAM was being 1987 yeah the CAD/CAM was being developed by France remember that? The whole the whole thing started in France and then the French government and then it somehow it ended up in LA and then you know it's moved around but when I guess 187 they thought that was going I was professionally taught that the CERAC 1 was going to bankrupt the labs and we'd all be cherished site milling within five years and now it's 32 years later and I still use my lab man the most even though I've got CERAC1 CERAC2 I have it all but I like lots of tools in my tool chest because I don't know who's gonna come in for what but what's the status of chair side milling nurses laboratory milling?

Christian: Howard I think we're aging ourselves a little bit to the younger listening to you because because as you just said you know when I joined obviously and you you said it in your intro I'm a lawyer by trade so I had no clue about industry right so one of the conditions when I started that I put the company that employed me was the first year I want to get educated I only work half days and then I got deployed three months to a dentist in Switzerland actually the guys too is a friend of mine he occasionally lectures for me great professional relationship over 30 years and he happened to be an associate professor in Missouri and I saw the first CERAC professor was working on and you know we had this we had the first remember the first setting once you know it was a blob of ceramic in a sea of bonding agent right hundred fifty microns sometimes and we came a long way the precision of chairside milling today is really outstanding however you totally right I think the projection that within five years so let's say the mid mid 90s the laboratory profession would be wiped out is grossly overstated you know it's a little bit like the old saying you know the announcement of my death is grossly premature. So what do we see, we see an awareness of dentists that there is a an array of treatment options and we can now service different customer needs with different treatment options if you have a clientele that does not want to do three appointments right but you still have to look after them then same-day Dentistry is the answer and if you have a more complex a crown or an inlay treatment in the past it was virtually not possible unless you had an in-house lab right and even then it took too long but now with chairside milling you can do some same-day dentistry for these applications let's say realistically up to a three-unit bridge right and for everything else the lab is still there and the lab is still the better and more economical way to do it and this will not change but the digital revolution will change the way how these things are fabricated and how you can communicate with your lab right you have real-time communication there today you have you have online consultation while the patient is still there with your tech or somewhere in the world if you wish saw right we have solutions today that we did not have our disposal years ago we do an intraoral scan we shoot it off to the lab and there might be somebody sitting in the Philippines doing the design for that restoration sending it back to a machine in the United States that Mills it out and the next morning it pops out in your laboratory right, this is the true fascinating part of it.

Howard: Well so what was the company for digital equipment and you said Ivoclar Vivadent mergers an activation about what company?

Christian: We acquired Vieland in Germany.

Howard: Vieland?

Christian: Yes and Vieland was one of the pioneers of Secunia and digital milling and we acquired the plant we incorporated the company into our set up and we went global with it and then you know merged it with our production capability and now we have a full array of lab and soon chairside mills built in our facility in both Austria and we have the one which is when you look up on the net I'm thinking looking at you you most probably on the computer and you can put in program mill one and you see this beautiful table top machine round modern form almost apple like right and it has a five block chart a changer so you run it you run it from your Apple device and it's right there and as we speak we launched it in the United States we just did the official launch at the ACP in Miami two weeks ago was a very very nice and welcomed.

Howard: I want to ask since you're a lawyer I think you could answer this clinical question better they young kids are always saying you know they believe that you know EMAX for fixed prosthetic crowns in the front for Beauty translucency and then they want zirconium in the back for more strength but I mean you're a lawyer where do you draw the line because when you get to first year first six year molars girls they have bigger smiles show more teeth now when you get a guy like me I don't even show my gold crowns but where do you recommend EMAX switch from EMAX to zirconium to go from beauty to strength?

Chirstian: Let me take you on an aesthetic journey all right and your younger viewers might not remember this the younger townies but you for sure do how did the aesthetic revolution starts with Empress right entrance Empress was and still is the gold standard in interior all ceramic restorations but then I remember I remember when we last talked in Phoenix you said you know and it is really great now you you're launching this Emax and it has more strengths and we talked about then the demand for us well you know Empress I can only use in interior situations I want to go at least two premolars right and what did we do we did slightly slightly compromise on aesthetics versus Empress which is still the gold standard right or not to pulling that problem who is different with different chemistry lisam that silicate we created a product that now as you could see at the ACP in Miami has an unparalleled success rate for permanent restorations. I mean the research that Dr. Melamine published lately in the Journal of prosthetics is unbelievable person on this is unbelievably successful and now we are talking about the individual crowns fully monolithic in posterior situations and it makes us show that it works however younger townies came to us and said but Christian you know i don't want to compromise on aesthetics but I want to I want to have conventional cementation I want to do round houses and I will class statex so again we looked at it we did not compromise on our aesthetic demands and zirconia is not zirconia let me tell you that and we created Emaxs crime and with Emaxs prime we now have an offering where you can go all the way to round houses and and for those of us who have seen you know multiple single units being adhesively inserted into the oral cavity it can be a hard job for a dentist to do that right hopefully nothing goes wrong chair side because you know if something goes wrong and you're having a hard time is your patient right but now imagine with Emaxs prime you go for multiple units and bingo one shot it's done so again it's it's the arch of aesthetics with different product solutions and the offering.

Howard: One of thethings I've been really excited about and I you know I think I did like 12 of them yesterday is I'm when that when the aesthetic revolution came out the most hardcore speakers like put a piece in little increments keeping put a little on this wall cure a little in that wall care man I love these bulk fills yeah that's so much easier faster well how's the bulk filtering so you don't have to do ten increments?

Christian: Bulk fill is a great thing you know but you know that's just the start of you know you had the aesthetic revolution and now we have efficient aesthetics we are all about we're all about now taking it to the next step and efficiency in the clinic is the next is the next frontier that we have to address and we just brought out a new material solution and and system solution which we call power pure three second power cure it's a whole system of a new queueing light and new material also bulk replacement material and now we have the option I don't know how how are you scheduled but I would think you know is how your schedule and how you work always on the run you must probably schedule to to direct restorations complex direct restorations an hour but if you have a molar situation or premolar situation with this system you most probably couldn't schedule three of them and that means that you have a 30% 30% increase in efficiency without compromising aesthetics now forget the material costs think about your hourly costs in your practice and I believe the number is still around the $700 most probably total costs for dentists per hour right?

Howard: Right

Christian: So if you can if you can schedule one more direct restorative appointment in that hour that makes a hell of a difference.

Howard: Oh absolutely, I want to take advantage of your vast international experience I mean I think sometimes when people don't get what others are saying they you know they haven't lecture around the world I mean I've been my boy sake dad quit telling people you know lectured in 50 countries you've been saying that for like ten years it's got to be like I'm going to Israel next week. Looking around the world, I want you to talk about one thing that's glass ionomer why do you think Australia New Zealand Japan use more glass ionomer than United States North America, first of all do you even agree with that assessment?

Christian: I fully agree with that assessment.

Howard: You know and I'm sure and those are really I think the greatest country ever built I mean the greatest city I've ever seen is Tokyo so why twins Tokyo loved glass ionomer but not buffalo?

Christian: Yeah look I did my postgraduate time in Tokyo so I spent I spent two and a half years in Japan I speak Japanese still I still when I come back to Tokyo I share the same sentiment you have I love that city you know I I still go to my local sushi shop when I'm there it's just a great a great city and the Japanese people are great people period now why Australia well there's this company that is a very very honorable and great competitor of ours from Japan and just like we started out you know which artificial teeth and and composite materials and ceramics right they started out with glass ionomer cement and they went and did research and did in vitro studies and in vivo studies with a guy in australia gray amount and that research was very successful i mean glass ionomer cement as we all know has has quite some advantages right and they developed for example the sandwich technique where you did the baseline I was glass ionomer cement and then you filled it up with composite material mining so I worked in Japan and I worked in Australia my first job as a managing director of a company was in Australia New Zealand I actually called traveled as a rapper in New Zealand and I lived in this environment I didn't have a glass ionomer cement luckily enough at that time we struck a deal and we would actually be the material of choice on top of glass ionomer cement so it's historically it's a historic event where companies had market strengths companies had unique knowledge and they were successful.

Howard: but do you think back to the amalgam did you think glass ionomer having the active ingredients um called bioactive do you do you think these will withstand biological invasion from eukaryotes and prokaryotes and all the life-forms living in the mouth you see that in the research?

Christian: I mean the research shows that that the release in glass ionomer cement controls the gap and there is obviously also in the connection between the tooth and a glass ionomer cement the issue is the compressive strength is not there, that's why I said you know for me for me you know not being the researcher you know when you come up with a product idea it's very easy so I go to our research team in Japan and I say you know you 13 discipline guys you know one of the strongest research team in the world come and 70 people is with a master and better right I say look I want I want amalgam performance and glass ionomer cement and aesthetics and get control make it and then they go to work right and what comes out of Cention I believe that we have the better solution do I have ten year of clinical studies no I don't because you have to start somewhere right?

Howard: Yeah and I just want to say something to the kids out there make it you know how when you're young and you're getting married having kids you think someday you might want to go to Hawaii or something like that I think what every dentists around the world should do is you have to go to the Cologne meeting in Germany at least one time they only have it every other year America's dental meeting is so fragmented there's 50 states every state has a meeting then there's a bunch of regional big meetings there's so many meetings but Germany or Europe says let's just have one great meeting every other year because it takes companies two years to listen to their customers go back to the drawing board change the ingredients and it's a two year product cycle and they're stressed out of their mind just to go from talking to you at Cologne and then delivering what you asked for two years later and when I was on those trips I took trains and I went and visited caveo Sirona but my gosh when I saw Liechtenstein I mean you guys I mean you have no idea what a research facility is I mean when I was there remember when I was there the Dead Sea was still just sick I'm an old man but I mean I think you have like 80 PhD researchers in lab coats and you'd start talking these guys and you would say something you heard from a lecturer and then those guys would go to a grease board you could just tell they were on a whole nother level of understanding organic chemists I mean it's literally mind-blowing what is your R&D; team up to is are you up to 81 now?

Christian: 175

Howard: So you know, you tracked it, so you've got 175 PhDs?

Christian: In the head office yeah.

Howard: Wow

Christian: Look Howard you know the beauty about the company is that we we are all having a limited pot of money I will cloud will never never put the lid on on research this is the lifeblood of us we have to we have to go forward and we have to be innovative I mean yeah this new passion innovation those are not just three tech lines that that you know we like to talk because everybody has you know everybody has to have a tech line I believe that encapsulate who we are who we want to be and and what we continuously deliver right I mean innovation is the lifeblood of our company and so we need the brains to deliver it but frankly speaking I mean you put a lot of pressure right there on us when you set a two-year product cycle you know that's that's tough I mean if you go basic I mean we have some projects that are already in the making for six years and they are not due to come out in another four or five so you you have in a company like ours and in all the major companies you have basic research and you have applied research and and you know applied research can be faster but basic research I mean think about think about how long it took right how long it took to actually get the first scanner out there intraoral scanner but right remember for example dick bronty's remember bronty's in Boston?

Howard: Yes

Christian: That then was bought by 3m you know we're talking we're talking start of the 90s right?

Howard: Right

Christian: It's million of dollars

Howard: So I like to offer historical perspective to the thirty year olds especially when there's two guys have been in dentistry for thirty years and they're under thirty I'm up the street from Liechtenstein Austria you saw Sirona which used to be part of siemens and then their CEO thought well it's over we're over waiting to healthcare let's spin it off and I'd like to do it Johnson Johnson and all these big companies like that and when they split it off nothing changed but later down the road they married Dentsply and now Danaher has just spun off in Vista do you are you dating or courting anyone do you have wedding bells in your mind?

Christian: Remember what popover said Bob Ganley our previous CEO we are big enough to compete with everybody and we're small enough to know our customers in person we are I think I can say that with pride we are viciously independent we are proud to be independent and we have one big advantage our single focus is dentistry there is nothing that distracts us all the companies that you just mentioned the dental department normally is a part of a larger going concern sometimes an afterthought by courting someone somebody we are always looking for opportunities to make acquisitions that make sense to us right we made acquisitions like when we decided we want to boost our entry into digital we bought Viland right when we realized that we needed some software competence and dental we bought dental softworks right but we are a company that has grown more organically than thing else.

Howard: So you just walked into the next question you know there's a perfect segue you said you're large enough to compete with anyone but small enough to know your customer well you're talking to a bunch of kids right now that are under 30 and they're there on all these smart phones they're on apps are you gonna sell them Ivoclar Vivadent on Amazon? I mean and and trust me if you your lawyer if you can't answer some of these questions just say shut up Howard next question but they ask that all the time.

Christian: So you see first of all when you google Amazon right Amazon as we both know we both Amazon users I when I fly a lot right what do I read Amazon Kindle right and when you Google Amazon you will find Ivoclar products there because I Amazon has two ways of doing it I can deal with Amazon directly or my authorized dealers can go into the Amazon Marketplace right and some of these dealers do and I will not stop them. I strongly believe that at this point in time when it comes to our product portfolio we are not just talking about and UPS FEDEX and Visa Card solution right we also talk about of course we talk about ease of access but we also talk about education we talk about making sure that the 30 year old kid that wants to use our material knows what this material is supposed to do and how to use it properly right and for that that you need more than just the Internet I believe at this point still. We invest heavily in education we have we have I see des these international centers of mental education most probably our company has the most industry based industry financed educational centers in the world right just take take North America you start in Canada and Mississuri you come to immerse in the Buffalo area you go to Sarasota bingo all run by IVA claw and we have as you remember very well from your visits in Buffalo we have full house almost every day this morning when I walked in there were 40 dentists walking through the door for a catkin course right we do this every day around the world I have a Center in Tokyo have a Center in Osaka I have a center in in Guangzhou I have a center in Chen in Shanghai have a center in Beijing but who has that who has that I have a center in Jakarta I have a center in Mumbai in the Middle East this is part of who we are and we believe that this is also important but yes access to information access to supplies is important.

Howard: When I spoke in China I got to have I had breakfast with the president of the Chinese Dental Association and we thought it was so funny how we both of the countries had about the same number of dentist about 200,000 yet they had a billion 300 million people and we had 325 million people and we were talking about how diet has changed all that and being such the worldly man you are and seeing all these markets and continents how different is dentistry from North America to Asia from Europe to Africa to South America and how does that affect your thinking?

Christian: Howard I think you touch on a very interesting point there saying that China has the same amount of dentists that we have in the United States it's it's still a true statement right when I came to China to live there and to run a dental company in 99 mile one of the one of the publicized goals of the Chinese strata logical Association and the government was to build a hundred new mega cities of multi million numbers and I spent on and I was involved in that that discussion and the first question that I had is well if you move another ten million into a new city you have to have all these services including dentistry how how are you getting the dentist there and I looked at I looked at the output of Chinese dental schools and it became for me self apparent that while we can build the infrastructure in China easily we didn't even have enough faculty to train enough people leave alone having enough talent so one of the biggest bottlenecks there was qualified dentists it means if you one of the challenges that I see in these countries is we need to come to a shared treatment environment you know a little bit like in general medicine where we have medical practitioners right nurse practitioners we need to have a system that under the supervision of a dentist allows more people to be treated we will have also efficiency gains with digital but when you look at the the computerized dental treatment options right that are discussed not quite sure that this will be you know I don't see a da Vinci robot drilling holes in the near future but the differences are that whenever we go in especially in emerging markets we see an increase of carriers there is a reflection of nutrition changes and one of the things that that are very dear to my heart is and I'm on the task force of of the FDI the vision 2023 task force one of the things is if carries is the largest and most prevalent non callable disease in the world and if we really are honest with ourselves most probably no other disease in the world causes more instructional hours for children being missed yeah more money being spent then I think we have an obligation as as being in the oral health business to address the arrest of caries period this is the biggest challenge that we face.

Howard: Yeah it's the most common disease in the world and it's and pareo is in the top five I think so cavity number one pareo top five and it's just it's just an amazing so when so I think we talked about directory sorters fixed prosthetics you know your I really wish you would do to help us homies out so much like we always get all these technical questions and every time I read these questions like here's the question today just popped up today two questions about bonding Emaxs four quick questions about bonding an Emaxs crowns are there clinically significant differences from Emaxs press and Emaxs ced that make you before one to the other number to the office like working in says use it for 90 seconds I can't see how long or y'all touching Emaxs if you're using nine percent hydrofluoric acid but when I see these technical questions I always think of all those PhDs you got in Lichtenstein and it's like man I wish you would put one of your one of your the smartest scientists you got because dentists they're there so you know they know math physics chemistry I mean dentists are probably the only ones in town that know the difference between geometry and trig I mean they get they beat up the detail so much and and they could use that more knowledge can you legally do that or is that or?

Christian: Howard we of course we of course have a helpline that is always available I mean they all pose...

Howard: What is your helpline?

Christian: You just call us when you go online you can see it right on top there at us is the it's the u.s. 100 number you can call our customer service they can we have more people in the Amherst facility with a PhD dentists as well as material researchers right now some companies everything they had office overseas now it's a little bit bragging but it's really true and you can I mean you know George townski right?

Howard: Oh yeah

Christian: I think he can answer any question you throw at him we have Dr. Shashi who is a young guy who can connect to those 30 year old townies you're talking about right now and he will be in their shoes he knows what the challenges are and you know I've just been at the ACP and one of the things that makes me enormous leap route is how the ACP brings in younger still in school and qualification or an internship the prosthodontist and we connect with them as much as we connect to the guys that have been there for 30 years right.

Howard: Right

Christian: You go to the AGD if you go to the AGD and the young AGD dentist to have a reception guess who you will find there you will find there Dr. Shashi and me. I have a vital interest personally as much as as professionally in passing on what we have learned and listening to these young dentist and their aspirations and you know I'm always I'm always surprised of the changes that we are recognizing you know in how they approach the profession right then when you came out of dental school you for you the role was clear I want to be a single practitioner I want to be self-employed correct?

Howard: Right

Christian: I mean yeah in your DNA the intrapreneurship was hard-coded well today we see the graduates from dental school saying wait a minute no I want to be in corporate environment I want to have you know 9:00 to 5:00 sometimes or it when you when you went on vacation I remember when we first met when I came to the state's first and and your kids were much younger than like and and when you took holidays I remember you told me I'm stressing because I'm not in the practice and it cost me twice I don't have income and I have the costs for the vacation right?

Howard: Right

Christian: and then you get generation says well I want I want to have three weeks of vacation paid vacation thank you very much so when you listen to this then you also realize that maybe our view of dentistry as being the single practitioner has to change and we have to take into consideration that we most probably will see some shift the jury is still out how much into kind of a corporate dentistry environment one providing providing dental services if we think about how it would be discussed for years when I was on the board of fellows at Harvard the issue of oral health being part of systemic health right, it's the only orifice that somehow artificially has been separated from the rest of the body right?

Howard: Right

Christian: and when we think about this and we think about treatment concepts in the future maybe dental practices in the future are an integral part of general health practices all of this we have to take into consideration and you know the thirty years old they will tell us where it's heading and how did we generate innovation in the past the same time as in the future as you said before you come to Cologne you talk with us and you say you know what Christian you should do this or that you know that would really help me innovation is not coming from us innovation is coming from listening to our customers and the same thing is when you get ready for the dental practice of the future the young kids will tell us what they want and we have to be reacting to this in order to stay relevant that's the game you have to stay relevant.

Howard: You are sitting in a very neat situation because to me it seems like you're the most weighted influencer in dental laboratories and that in restorative materials so you get to see both sides of the fence the dental lab and the dentist the the kids coming out of school they got $285,000 student loans they're not really know if they want to invest in an expensive chairside milling unit what advise what business advice would you give may have you got two hundred eighty-five thousand dollars of student loans if you just buy a CBCT that's a hundred grand a CAD CAM that's a hundred grand and a laser that cuts hard tissue another hundred thousand you can buy three things and double your student loan debt so I want you to put on your business dad hat and let's say your daughter just graduated from dental school and she says that I'm three hundred thousand in debt what technology well that I buy will help me pay down that debt faster and what technology is more let's not do it while you have three hundred thousand dollar student loans?

Christian: I hate to say and this is my this is not a company statement it's my private statement I hate to say it because we don't offer it but I would buy a CT scanner because the the advance of digital radiography will give you so many so many insights you know and it's a central piece of equipment that will give you a better a better insight into approach and it's billable.

Howard: Yeah I mean gosh when I x-ray me when and by the way Renton grin had the radiograph for years and years and years and years and dentists didn't even look at it until Delta Dental came along in 1858 up on the west coast that Seattle Portland California area and once they started rolling out dental insurance that covered a hundred percent of x-rays the domino machine of x-rays went from California to New York in about an hour and a half and if there's no if there's no insurance so when you have an insurance code so that's a great succinct answer there's an insurance billing code for a CBCT is there one for a lasers or one for a CAD CAM so that that's really good advice, what other advice would you give her in general?

Christian: I would go first of all I would always try if your dental school offers business course do it you know it always flabbergasted me from my very first doublings as a greenhorn into dentistry right where I came from I had to go to business school as part of my law education I had to go because the idea was maybe you're a self-employed lawyer you know you have and or you give advice and in business matters you need to understand business but even if you go and private practice think about this you will be a mid-sized family-owned company people rely on your judgments your nurses their families you know they are receptionists how can you run a business without having any business knowledge you use whatever is available before you go out to get business savvy you are also a business person that's my biggest advice and then the other thing is try to try as many materials try to look into as many treatment options you can look at do not just start with the one thing that you've been educated on though the one thing that you've been exposed on the one material try to understand you various materials and what their benefits are because as you said in the beginning in almost an hour ago you said as a dentist I love the toolbox that is at my disposal but what is the use of a toolbox if I don't know how to use and when to use the tool I think this is and if companies like ours offer sometimes free of charge education do it if academies invite you to go to a congress and to sit in our lectures do it do it.

Howard: Yeah I know rightly some do you just walk across the street I know you're shy and you're an introvert but if you just walk across every dentist wants a buddy and when they see something Green kid crawl out of school with a million quite there's nothing more fun I mean I went gosh I probably got 200 free lunches just meeting dentists and Phoenix the first thing they always said is hey after work I'll buy you a steak and it's like really all right no I get a free steak and all your dental knowledge just relationships relationships relationships but to hold your feet to the fire more and when I look around the global what do you put the global dental industry at you know it's about a hundred and ten billion in the United States but what do you think we are market that is a fraction of the pharmaceutical and general market and but what...

Christian: We are market that has a good track record in most we are growing steadily for years two to three percent every year.

Howard: but  what do you think the global dental market is?

Christian: I have to say I mean for us I'd say it's about five to six billion

Howard: Well you mean Ivoclar is five to six billion?

Christian: No no none of the target audience a fee that we address you know it's hard to say is it including the dentist services is it there's...

Howard: Yes the whole dental industry when a patient goes to the two million dentists on earth and gives them a dollar bill and says fix my tooth.

Christian: I'd say anywhere around twenty to thirty billion hard to say.

Howard: Twenty to thirty billion

Christian: Yeah

Howard: Okay so when I look around

Christian: Maybe around 25, per hard data.

Howard: I think statistics are funny because people will ask these exact questions I'm like you do know they don't even know how many people are on earth so you know...

Christian:I always feel uncomfortable because in the absence of hard data you know your guess is as good as mine you know and it's hard to say but what you but what I say it's a great market to be in.

Howard: When you would you agree with this so when you go around the world it seems like the two fastest dental horses are clear aligners and implants they seem to be growing faster than the rest of the endo pareo pedo cosmo do you agree with that?

Christian: Yes

Howard: and so if your daughter just walked out of school she's 25 she's got $300,000 in debt and she wants to take CE where she has a return on investment to pay back these student loans what CE. What would you really recommend she learns everything about your aligners and plants or what what would you tell?

Christian: Direct restoratives, look at your daily practice even the 30 year old will say the most people that come through my door and sit in my dental chair I'll do a direct restorative that's still the main income driver.

Howard: and what's amazing on to you kids out there is um he's so right I mean I'll see Dennis that once or twice 1 or 2 weeks a year for 30 years they go learn everything there is about TMJ and all those T'aime je T'aime je and then I look at their books and TMJ is even 1% of the revenue and I'm like don't you think it's a little mismatch that 99% of your C goes to 1 percent of your revenue I mean the bottom line went like yesterday I don't know how many piece I saw maybe 20 it's the same thing yet thanks broken tooth you know tooth broke you know. So you would say just stick with simple basic restorative direct restorative dentistry and fixed prosthetics?

Christian: So that's what I would say and then you know get an intraoral scanner yeah and then make smart choices for the patient that is in front of you whether you want to do it in-house or whether you want to ship it off to a lab.

Howard: and I want to also my dental school I want to throw them under a bus just kidding I love you MKC. I just lectured in a st. Louis it was so fun about a dozen of my classmates from the class 87 from Missouri we're in St. Louis it was so much fun but not only do they say CERAC would replace all the lab techs within five years ago education which didn't happen they also said dentures were going extinct that there was no reason to lose all your teeth or not so 32 years later with a herd of Homo sapiens of seven point seven billion our dentures going extinct anytime soon?

Christian: I would venture to say we see the Renaissance of removable and I'll tell you why some time ago when the FDI had its Congress in Delhi I believe it was in 2010 or 11. I got an invitation by the then president and she said to me Christian I want you on a panel for geriatric dentistry and I met for Camilla was the chair of geriatric dentistry in Geneva and she looked at the way you're doing here on this panel and I said well had the same question and I said you know what first I thought do they want me to talk about denture tease and denture colleagues and then I realized that you and I and those thirty year olds out there they will have their teeth longer and maybe maybe we have to face the fact that despite us living longer with our teeth our bodies are not designed for this so we will get arthritis our eyes will get bad right our pareo will be bad and I had I had a dentist tell me once well I have this 50 year I showed you the case 15 years ago and I put implants into him and this is what he looked at 65 and I had of course no idea that these implant supported bridges would be there and now he's 75 he can't maintain them and he said if I look at the outcome now that he's 75 I think I almost all treated him I should have done a removable and I think removable maybe you know implant supported removable that's the future and that will be done digitally whether it's gonna be printed or whether it's gonna be milled.

Howard: but you have the data so I want you to tell me exactly how you see us you have all these scanning impressions taking out but you sell virtual vinyl polysiloxane impression journals is scanning is oral scanning taking off such that your virtual 380 revenue from poly siloxane impression materials is it contracting because it's getting beat up by oral scanning are they both growing?

Christian: There both growing still but the growth of pine polyvinyl has slowed down significantly and the growth factor of intraoral scanning is significantly faster so once somebody invents the Silver Bullet and is able to scan soft tissue I think then traditional impression materials will have a hard time but in our BBS system in our denture systems we still work with an alginate based material you know.

Howard: Well I I saw a dentist in Tokyo that did some of the best crown and bridge I've ever seen my life with alginate so you know if you're a true artist if you're Picasso it's probably more the artists than the material sometimes I know you're a busy man I can't believe I got you to come on the show just down to two more questions you got to give me an update I lived in Phoenix I'm only a hundred miles from Mexico and you guys just had one of the largest events ever in Mexico 7,000 dentists house my neighbor of Mexico doing and how's dentistry down down in Mexico?

Christian: Yeah David Abbott our the head of our operations in Mexico I mean he's a genius I mean he he has continued the tradition of Ivoclar in Mexico and made it something even bigger he's doing a great job our market share in Mexico is bigger than we have here in the United States I have to admit you know there is a race right now you know we have our operations our subsidiary in Russia we have our subsidiary in China and we have our subsidiary in Mexico right and those three guys are viciously viciously competitive. So every year as a year grows to an end we all through I mean all these three try to be out there and try to have events try to engage with dentists and dental laboratories and every year you know when they get together at the international management meeting they pat on each other's back and say oh this year it was you but next year you know next year it's me so he's doing great he's expanding his operations as we promoted him to Central America and we're doing much better now in Costa Rica and other places you know we have the red office in Colombia which we are in the process of upgrading to a full subsidiary and then we have the subsidiary in Brazil which is also doing quite well I mean the Latin American market is very good to us and you know Howard not too long ago when I joined you know the emerging markets were not in the focus of Ivoclar Vivadent a lot of change since then we've grown exponentially and consistently double-digit in emerging markets.

Howard: That is amazing um well I'll tell you what I know you're a busy man and I'm not gonna abuse you any longer than I have to sorry wrap this up I just want to say Bob Ganley was the one of the first 100 he was number 94 and I just want to tell you that I always saw him as a not only a role model a mentor but his availability was mind-blowing I'd always think I mean this is before I was even lecturing or where he had dentaltown which was until 98 and you could call down there and he would answer the phone it's the same thing with Patterson I mean I could never figure out why every time I call Patterson asked for Pete Fershchet the CEO took a public they would say okay and then he'd pick up the phone paint and I'm just like how the hell does this guy so those guys really taught me so many lessons about being available to your patients I always say on dentaltown people say what should i do I just got this patient says she's gonna sue me should I call my dental malpractice or should I call my attorney or what should i do does like why don't you call the patient just call the patient I mean I've talked patients out of suing me before in fact I had a guy the other day was so mad at my buddy cross street I told him look I'll redo the bridge for free if you just promise you're not gonna sue my buddy cross street because you know you're not it's not like you're mister brush and floss and you know it's not like you know so anyway I just love Robert Ganley and again you kids you missed that he led the entire cosmetic revolution and the only thing I want to say about the digital scanners cuz I've had hundreds of lab techs on this show and they say hey if you don't take care of the tissue you don't pack cord you're not a good dentist and you have crappy impressions yeah and you go out by a 3Shape oral scanner guess what you're still a crappy dentist and if you handle the tissue if you handle the tissue and you're trying to be quality and the lap my lab man's they don't care if you use vinyl polysiloxane or an oral scanner they just want you to be a good dentist.

Christian: Digital doesn't make you a better dentist it gives you the chance to use tools more effectively.

Howard: Yeah

Christian: I mean you do spot-on and let me let me pick up one one one thing I appreciate very much Howard that that you do this shout out to Bob I mean Bob Ganley to all of us was a mentor but Bob Ganley also made sure that as a good steward you know that there was succession planning and and you know we looked all because we stand on the shoulders of giants right and I don't even try to slip in his shoes but I have a blessed with a great team here at Ivoclar of America and I have people that have been around that know the industry inside-out and as I said before...Chris Holden both are names that everybody in the industry knows and you know I can sit here and talk with you and look good maybe even you know but I I know very well I'm I'm looking good because of these guys picking me up every day being part of the team and basically Bob training me for 13 years to follow him yeah I mean you know when you've been a co-pilot for 13 years was Bob you learned a lot you observed me.

Howard: and he flew so many times from Buffalo to Lichtenstein that...

Christian: Every other week

Howard: When he got held up in traffic the captain would hold the plane did you know that?

Christian: Every other week

Howard: Yeah I mean they would hold, that was their VIP so is he gonna retire in a Lichtenstein or Buffalo or to be determined?

Christian: He is in Buffalo and he retired here and he's enjoying this and he's still on the board of the supervisory board of our company he still comes a couple of times to Lichtenstein and I'm of course I mean you know when you are together like this and you've met Bob and then Bob is much more than just a colleague you know pop is somebody you really want to go out and have a dinner with or a drink with right and I will continue doing this you know I value him as a friend I value him as a person that have greatly influenced my view and and and as long as he's willing to see me I'm gonna reach out to him you know.

Howard: Yes well I'm again it was good to see you my longtime friend best of luck thank you for all they do for dentistry it was an honor to podcast view and give Bob my love and I hope you have a great day go bills.

Christian: Thank you Howard and really appreciate your looking out you know for the younger generation. I think what you're doing is essential what you're doing is more business venture I think you also have a vital part in changing dentistry and you know what don't give up the provocative questions.

Howard: Yeah so all this and say one thing there you hear all these people time at work and passion and a purpose and I don't mean we blunt but you know your purposes is in the last 50,000 years a hundred and ten billion humans have lived and died to give us our present and what matters the most is not about the man in the mirror or you and your existence is that when everybody alive today is gone we're gonna have our replacements for our species which has grown from 1 billion to 8 billion from 1800 to today and so the most important thing about knowledge isn't even you using it on your patients the most important thing about knowledge is we wrap all that up in a present and give it to our replacement humans and they get to unwrap that when they get on earth and so every problem we solve just like when I was born there he had interstates they had clean water they had sewage I didn't do any of that and I just I think the most important thing for old fat bald retiring dentists that are slowing down like me is to make sure the kids coming out of school got every pearl you ever learned so they can do everything better faster easier higher quality lower cost and on that note thank you so much for coming on the show today.

Christian: Thank you Howard, appreciate it.