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1358 Dr. Faraj Edher & Dr. Richard Simonsen on the Digital Dental Revolution : Dentistry Uncensored with Howard Farran

1358 Dr. Faraj Edher & Dr. Richard Simonsen on the Digital Dental Revolution : Dentistry Uncensored with Howard Farran

2/19/2020 3:00:00 AM   |   Comments: 0   |   Views: 90
Dr. Faraj Edher is a Specialist in Prosthodontics. He is the Director of the Digital Dentistry Institute, a global educational organization that conducts comprehensive training programs in digital dentistry and implant dentistry. He regularly gives presentations, seminars, and workshops, both locally and globally, on a range of different topics. These topics include generalized and specialized presentations focusing on digital dentistry, implant dentistry, treatment planning, and aesthetic rehabilitation. His current clinical and research interests are focused on the applications of digital technology in dentistry, complex implant reconstructions, and aesthetic rehabilitations. Dr. Richard J. Simonsen is Assistant Dean for Student Affairs and Admissions at the College of Dental Medicine at California Northstate University. Prior to joining California Northstate, he was the Dean of the University of Sharjah, Sharjah, United Arab Emirates, and before that the founding Dean at Midwestern University, College of Dental Medicine—Arizona. He earned a DDS degree from the University of Minnesota School of Dentistry, and followed this with a Master’s degree in epidemiology and a certificate in Cariology. Dr. Simonsen has clinical and research interests in pit and fissure sealants and minimally invasive operative dentistry procedures.

VIDEO - DUwHF #1358 - Faraj Edher

AUDIO - DUwHF #1358 - Faraj Edher

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Howard: how lucky am I to be sitting in the podcast area with my idol and legend for thirty years 

Dr. Richard John Simonse  I mean you were that you were this starting Dean of a tea still with Jack Dell Berg then you went to Midwestern then you went to California then you went to where you went to school and so I'm with Dr Faraj Edher DDS master's in science diplomat a prosthodontist and he is the youngest prosthodontics or youngest specialist or youngest prosthodontist specialist as far as I know youngest specialist in North America as of two years ago at age 29 oh my god my baby's older than you and uh and so you went to dental so you're born raised and British Vancouver but you went out to dental school where he was the Dean in UAE mhm and the name of that school let me see you out bombing University of University of Sharjah College dental medicine so let me read your bio first cuz everyone knows who you are he's a prosthodontist and he's the founder of the digital are you the founder of the digital dentists I'm the director you're the director of the oak I'm sorry I am NOT reading here right he's the director of the digital dentistry Institute clinical assistant professor University of British Columbia he's a specialist and Prasad onyx he received his dental degree from the University of Sharjah College of Dental Medicine and then continued his master's in craniofacial science and post graduate special training in prosthodontics at the University of British Columbia he's a fellow of the Royal College of dentists in Canada and an active member of the American College of prosthodontist Association of province of Canada and the Canadian Association of restorative dentistry and prosthodontist he has founded co-founded and has actively involved with several international dental associations and his representing Canadian dentists and dental students multiple international platforms doctor editor is the director of the digital dentistry Institute a global education organization that conducts comprehensive training programs and digital dentistry and implant dentistry he regularly gives presentation seminars and workshops both locally and globally on a range of different topics these topics include generalized and specialized presentations focusing on digital dentistry implant dentistry treatment planning and aesthetic rehabilitation his current clinical and research interests are focused on the application of digital technology in dentistry complex implant reconstruction x' and aesthetic rehabilitations in addition to practicing full-time in Vancouver and Kokkola tongue hopefully them cook quick them quickly and what is that a suburb of in Korea which by the way is my favorite city in North America me too it's a sign every time in fact I think I do the Alaskan cruise a couple times just cuz the start sir dr. editor is a clinical assistant professor and guest lecturer at the University of British Columbia and has numerous publications in areas such as dental jewel dentistry and dental implants and I hope that you add dental town to your list and make us an article someday but so you're 29 Richard's a hundred and twenty-nine and I'm a hundred and nine it must be very different this profession must be very different from you where we started out with rubber base and polyvinyl siloxane and all this stuff like that and now it's all going digital

Guest: yeah it's honestly for me it's what I'm most excited about because I feel like I'm at the peak of the revolution of Dentistry when it comes to utilizing technology it's like it's like when implants were introduced you know 50 years ago or whenever they were introduced it we knew it was going to change the way we treat our patients and I think we're at that stage again now and for me it's exciting because being at the start of my career I can kind of jump onto that train and contribute to it and help advance it in a way that you know makes a difference I feel like Richard and I lived through the first revolution which was a materials revolution when we were in school amalgams I'm still old school I still believe that amalgams last 38 years I mean ever it's metal every ingredients antibacterial hell it's half mercury they never put that in a multivitamin the other half silver zinc copper 10 the whole thing's antibacterial and we replace it with an inner plastic but when Richard and I were in school it was full gold crowns and amalgams and the new pfm and then the material revolution the composites adhesive dentistry that's gone full spent and we saw I can't believe I lived through the beginning and the extinction of the pfm and and I'd say about 2000 was the beginning of the digital revolution and now it's 2020 so how does that digital revolution look twenty years into it what's what's bleeding edge and what's leading edge what what is still kind of fantasy and what is there 

Guest:well whenever  I'm in a room talking about digital dentistry I ask people how many of you used digital dentistry on a day to day basis and usually you know 25 30 % of the people raise their hand and then as I get deeper into it we start talking about the fact that digital dentistry pretty much means digital technology and dentistry so how many of the people in that room use you know digital radiographs or use digital filing charts so I think when we talk digital dentistry like you said from around maybe 20 years ago we started to see the introduction of this technology it's already integrated in every single practice pretty much in one form or another but the way that it's really new nowadays is more how it's being implemented in how we actually treat our patients rather than how we mark it or how we schedule appointments or how we chart or radiographs we're utilizing it with things like you know we're using augmented reality on a day to day basis in our practice at least we're using some version of artificial intelligence so it's those new applications and being able to merge them with a lot of the traditional old-school concepts that are tried-and-true that we know work but being able to do them in a much more predictable way that to me is the most exciting thing about this digital technology it's the predictability of it and it's the ability to communicate so much more effectively very similar to what we're doing now like you're saying the power of a podcast right it's utilizing digital technology to communicate so much more effectively than we could have ever communicated before

Howard:  yeah cuz it started out it was um it was a radio wave and podcast is just a radio but now it's digital just like YouTube we started out on the TV three channels and I can't even watch the TV anymore because you know you have these like hundred you just surf through a hundred channels like I can sit on YouTube and find something in three seconds yeah create crazy times digital dentistry um I'm really I'm Irish so I'm really excited about artificial intelligence because Irish natural intelligence is very  challenging so I know that uh I know when I have my Irish natural intelligence up here that the I'm gonna bank on the AI and is AI am coming did you see it making an impact on prosthodontics today 

Guest: not so much on prosthodontics yet it's mostly so there's a lot of research going on there's a lot of startups looking into using artificial intelligence for example interpreting radiographs and things like that but I think its first real application in terms of practicality to everyday practice is it now being integrated in digital impressions or intraoral scanners right so some of the newer scanners now have artificial intelligence in them where when you take a study model on a patient not only are you using a digital impression but that same software will recommend to you or at least you know suggest to you where there's occlusal caries where there's interproximal caries and this is very new but the initial evidence that's coming out is actually showing that it's pretty accurate and sometimes more accurate than definitely more accurate than IR our eyes and some some studies are showing that it may be more accurate than a radiograph so having that ability as a starting point to take a study model and right there and then identify where there might be caries and whether it's incipient or you know more progressed that's that's a game-changer and we're only gonna see more and more that 

Howard: yeah I'm I'm really interested in the military you know when a submarine goes out on a mission it's gone for six months and they can't surface because you know you have a cold or whatever and so they've developed an amazing AI for you just sit down they knows your age and knows everything about you just tell their symptoms but anyway everything I see on that is there like 94 95 percent right but when you go into an emergency room they're not even in the 90s right and I see the biggest they say the biggest bias is like if I'm a female Native American Indian and my doctor is a male Irish guy you know just of the more part the patient doctor is the the more errors are I've seen him I want you to settle the big process I go I you know it's an object-oriented programming language what do they call it Python so you so they they they like reading impressions they like reading x-rays they like anything object oriented and I've noticed some some insurance companies are using it now they just busted some lady dentist in San Diego who I guess was resubmitting the same x-ray for a root canal to I think it was like $600,000 or something crazy but anyway this she's looking at ten years just but you know and a human wouldn't remember that he'd seen that x-ray a dozen times with a I did but when I talked to the labs it's funny how Dennis will say well if you scan the impression it's so much more accurate and then I'm old school I'm still polyether MPEG um I know I should switch to polyvinyl siloxane but I'd probably have to go to therapy to do that I mean I'm been on it since 80-85 I am when I was started with him for gum it was owned by the Germans now it's uh Bob by 3m but um every lab tech that I talked to says you know sloppy dentist sloppy you know of here you're sloppy with the scan or you're sloppy with amber game you know garbage in garbage oh yeah I garbage and they always tell me that for their lab and their clients the sloppy ones when they switch from whatever they're still sloppy so do but for the young kids I'm these dental school deans this guy and killer you know dental schools not cheap richard has six homes and four Jaguars and three Porsches and  um so they want to watch their money so a chair sight milling machine CAD cam that's one hundred and forty thousand a CBC T that's a hundred thousand bio a slate they can make three purchases and double their student loan debt so when you talk about intro scanning they want to know do I really need that or would it be smarter with four hundred thousand our student loans just take a an Emporium again

Guest: it'll depend on a lot of factors in my opinion it's for any younger dentist it's 100% worth the investment and I'll explain why so first of all if we're talking about intraoral scanners to replace PBS or impre gum or whatever you're using traditionally they're becoming more and more affordable so with new competitors coming onto the market we're looking at so in the past two years an intraoral scanners now available at a price point that's thirty to forty percent less than what it used to be and that's only going to continue because of competition and because of people getting into the market so in terms of in terms of that it's  less of a barrier to entry there's but this is dentistry uncensored so drop names I mean so for example the medics canner medicine edit scanners so the medic scanner came into the market and it was a it was a big hit for the reason that its price point was around thirty percent less than you know the higher end scanners like the three shaped scanner and the primes can scanner so CEREC and  three shape so so so dense why Sirona that's that's Austria that's high cost and three shaped over name Denmark high cost yet it is Korean is I believe Korean yeah and so when you say thirty percent less will give me the numbers like I'm not sure what it is in the US I know in Canada so instead of instead of a trio scanner being around let's say forty thousand to purchase we're talking about something in the range of 30 27 to 30 something like that okay and then and then there's other scanners too so the reason I mentioned the metadata it's also been shown to be pretty accurate whereas there are scanners that are in the $20,000 range so half the price point but no one's no one's seen that their accuracy is comparable to those higher-end scanners so what ends up happening just like with anything else right this isn't unique to dentistry once you have a competitor that comes into the market at a lower price point you have to start competing with that so three shape then released a more basic scanner with less features but at that same price point so it in my opinion have the same price for you so as medic you know so the three sheep scanner was more we're talking Canadian which but anyway huh is it monopoly money or is it not getting but three shape you're seeing three shape in Canadian met it was about thirty thousand three shape was forty thousand something and so now three shape is having a lower-cost option yeah the basic yeah and that's it's  going with exactly what you're saying which is depending on your needs so if you're just getting into you know running a practice or or purchasing a practice and you're not ready to make the investment where you need all the features that are involved in a you know fully functional full option three shape scanner you could invest in a more basic scanner and then add on certain apps let's say to it as you progress and as you start using them more like smile design and implant planning software's and things like that so in terms of an obstacle to entry being the cost I think that's changing and it's going to continue to change really quickly but then when you also look at it long-term so most people and you know my generation and newer dentist's plan to be practicing for a long time and you're not gonna be using the same scanner forever you're gonna have to update it you're gonna have to upgrade it but what you have to also account for is how it affects patients so I get a lot of patients that come to see me specifically because they've heard that I use technology that's more advanced than any other clinic around us and it makes a big difference not just because of the show but because of the communication like Howard: I said well that's a great point currently cellphone do you have my phone that's an iPhone and how old is it it's pretty old and broken how old would you say this probably a couple years to two yeah and how old your laptop a year yeah that's what that's one thing kinda understand cuz like go to a CBC team which is on her grand um the the patient knows every time I go to the doctor and that they want a picture and image they send you somewhere else everybody send you somewhere else but if you bought a hundred thousand dollars CBC T well as soon as it's paid out for like oh great I'll have for the rest of my life you're gonna want another one in five years same thing what you're seeing scanner it wouldn't wouldn't a better business model be something like at Netflix or a sacrifice starting to see that 

Guest:so for example with 3d printers now CT scans I don't think that's an issue cuz we've been using CT scanners for so long that the advancements being made aren't necessary for everyone so in other words if I have a functional CB CT you know in five seven ten years I won't necessarily one in you one unless I really want the new features like facial scanning or things like that but when because 

Howard: I think it's funny how you said your cell phone was old do you call it old it's true I mean um so so but you you will the intraoral scanners like medet and three shape do you think those will upgrade more faster than a big cbc –

Guest: yeah absolutely because they're newer right so they're because they're newer there's so much more advancement taking place so the scanner that i had two years ago is nowhere nearly as good as the scanners that are on the market today where is the CT scanner that I've had for two years is probably just as good as the ones today cuz not as much advancements taking place in that field but the subscription model is interesting because carbon have you heard of carbon printers they're pretty high up there when it comes to you know the best printers in the dental industry they've more recently introduced a subscription well or a lease model let's say to purchase it because of the high price point what we're also seeing for intraoral scanners is labs actually purchasing scanners and giving them to dental offices sometimes for free and all they ask for in return is a certain fee added to each lab case you do with them and the reason they do that is because I'm an intraoral scanner for me as a clinician is an amazing thing in terms of efficiency in communication but when you talk about a dental lab that's a whole other world like they  love this technology and tell them why they love it because it makes everything so much more productive for them and

Howard:  getting an impression and you know they don't do that from my school un-pc but any of the schools that Richard started they when they Center the impression there's still that bloody cotton roll inside with uh with juice coming out of it and then you got to pay a human to pour it up then you got to wait and then you got a you know you got a sub where it comes in a scan and then you have the error stacking so if I if I take an impression say that's 20 microns off then I poured up in stone that's 20 microns off and then I wax it up and take that off you know so you just keep stacking these 20 micron errors and next thing you know you have under microns so if it just comes in digital I don't have my labor I don't have all these errors so I can see that um for the intro scanner amazing but for the  big hundred thousand dollar CB CT that you're a brass honest if you were if a general dentist working with you wanted to send his patient for a CBC TV how do you charge for that or are you good with that or do you not like that or 

Guest:there's different models in our practice the way we do it is we don't charge for CBC T's I mean if someone comes in specifically just to take a CB CT we charge something similar to what anyone else would charge was I think it's around the two hundred dollars or something in that range and but for any of our existing patients or new patients we take a CBC because we're an implant based practice as well we do a lot of implantology so we take CT scans at no charge absolutely no charge whatsoever there would it but 

Howard: what if a young kid just came out of school with 400,000 our student loans and said I don't I don't want to buy on her when I and they're probably only doing you know a couple implant cases a month if they just send them over to your place would you would you like that or would you not like that or would that be good or bad or 

Guest: I mean I don't see why would be opposed to it we would definitely be I'm doing that it's but there are radiology centers available at least in Vancouver right so people who don't place enough implants to justify the cost they send their patients over either to another office like you said or they send them over to radiology center and have the CT scan taken yeah but it's it's pretty much all so it's a numbers game too right you know how many implants you're expecting to place you know what the cost associated with sending a patient out is plus the convenience and then you know long-term whether that makes sense or not for you to have an in-house scanner right so um so you're you like that the the metod scanner is that what you're using no we use primarily the three shaped scanner the three same yeah and and what do you what do you uh what's the pro what 

Howard: why should she get the three sheep scanner and throw away the vinyl poly slug saying oh so

Guest: I I don't think anyone should specifically get a three shape scanner I think people should consider switching to intraoral scanning in general opposed to a PBS the reason being well accuracy you mentioned that but you said you use a three C is a three shape for for specific reasons for myself in terms of how we function with it so let's talk first about the advantage of intraoral scanners versus traditional impressions and then we can talk about the different scanners themselves but comparing intraoral scanners to conventional impression materials number one is accuracy there's more than enough evidence over the past six seven years that shows that when you fabricate restorations using an intraoral scanner and a digital workflow you end up with better adapted margins with better fitting restorations in comparison to the traditional workflow that doesn't mean the traditional workflow is inaccurate it's clinically acceptable because we've been doing it for hundreds of years and we probably will continue to do it for a long time but we know that this workflow is as accurate if not more accurate so that's number one number two is the other point that we mentioned which is no storage you know you don't have to worry about models everything is saved on a hard drive or on a server somewhere being able to pass on that information to the lab so I can work with a lab in Germany if I wanted to right and I can they can have my case over there seconds whereas so for me as a prosthodontist being able to relay that information to the lab and be able to work with anyone I want whether it's in my area or outside of my area have them go through a digital workflow designer restoration for me send it back again via email and then all I have to do is press print or mill and fabricate that so that sort of communication with the lab is  a big deal but all of those things patient experience right there's a lot of evidence and a lot of studies that have been done but it's also common sense every patient prefers the digital impression over the conventional impression no one enjoys the goop in the mouth that hardens after five minutes so that makes a difference too but all of that aside the main two things that I always say are the biggest advantages of digital technology and dentistry or predictability so being able to use this technology to predictably get you know good results again again and again and number two is communication communicating with my patients being able to write there on the spot you know take a scan and show my patient okay you can see the crack on your tooth here you can see how this restoration has an open margin being able to visually communicate things or utilizing things like smile design and instead of me saying you know I'm gonna make your two central incisors look better and then trust me I'm actually showing them these are the issues these are the challenges that we face and using this technology here's how we predict the outcome we'll look like we all follow informed consent and utilizing this technology in my opinion today is the closest we can actually get to informed consent because you're able to use visual tools to communicate that information to the patients rather than just verbal you know predictions or verbal pictures that we draw 

Howard: so when you say you're a full time brass honest um how does that break down into fixed versus removable I mean or is it 

Guest:I probably do 20 percent 15 percent removable mostly fixed those mostly fixed it just um one of the problems I have with fixes um you know the

Howard:  people who need all these implants you know they're they're not the vegan yoga instructor who's you know hiking five miles every morning it's always there always Irish alcoholics smoking drinking and they pareo and they lose all their teeth and then you put in all this fixed stuff and their behavior doesn't change they can't clean it but I get it so it's just psychological that they don't wanna some something that can snap out to clean the so for patients that aren't willing to like you said 

Guest:if we see that someone for example has a certain tendency or a certain habit that has us you know believe that they're not gonna be able to maintain a fixed restoration in their mouth on implants in the first place so a lot of times it's like you said well the number one cause is periodontal disease number two cause is carries right so both things that are directly related to hygiene and not being able to take care of things but the comparison that we make when we take a look at things is what's the difference in how they're going to be able to maintain that restoration so there is the option of just a removable denture most people don't enjoy that most people don't get the quality of life and let's say the mastication function that they want with removable dentures so we have the options of utilizing implants for a fix completely fixed or a relatively fixed but also detachable so something they can remove and clean based on at least all of the based on most of the studies that are out there a fixed prosthesis let's say that's on implants that's designed in a cleanser bowl and hygienic way with a patient that's willing to clean it and they're gonna have to be willing to clean it whether it's removable or fixed so if it's designed in a hygienic cleanse herbal way and a patient's given the tools so we give every one of our patients a Water Pik that has a fix for free everything we can do to get them to maintain it and clean it properly so a patient that where the bridge or hybrid is designed in a way that it's cleansing and they're given the tools to clean it and they're willing to actually spend the five minutes each morning each evening - cleaner you'll be able to maintain a fixed prosthesis probably just as well as they would irremovable because even with a removable even if you have a bar or locators or whatever it is you still have to remove the denture you still have to rinse it off you still have to clean around the implants so that that sort of time that you spent cleaning you have to be more than motivated enough to do whether it's fixed or removable and the real issue is with fixed which is really what's given hybrids and you know all on fours and those sorts of concepts a bad name is the fact that a lot of times they're not designed in a way that's cleanser will not designed in a way that helps the patient clean them and that's a whole other topic right as to why 

Howard: I would just say that the number one predictor of future behavior is past behavior and so what led up to them losing all their tea here you know they're not gonna you know they're gonna change but the thing that they stay no from is that when you go to other surgeons who give you an artificial knee artificial hip I think it's amazing how they come into the office all excited and say yeah my doctor he said it were real good he said I should get at least five years out of this I thought yeah I've spent $50,000 on two knees and satisfaction equals perceptional minus expectations and he already set the bar so low five years I mean he'll he'll probably warranty a five years whereas so many dentists they never they don't drop the price and they don't drop the longevity and so everything we know on case presentation if if the doctor doesn't say the price you know looking at the eye and say you know and we can do this whole thing for twenty thousand dollars when  the doctor says that with confidence then when the person comes in to do the business range but he goes through but when they said they're no task all these open questions like well would you like to have it done nice and perfect and lasts forever and all this uh well how much is it all that Suzy come in she's thinking damn he you can't even see the number this is a game but when you look him in the eyes and you dropped the price Oh more read taught me that and and I guess his funerals next Saturday right yeah his funeral is uh his funeral is yeah the 29th at 11:00 and but he taught me that you got a look at me that enjoyed the price but the other thing you got to do is for satisfying Cree satisfaction - perception perception what happen - agitations you have to lower their expectations to raise your satisfaction so you know you do it with pain you say you know when this um with the sanest you know after I do recognize him you know when this anesthetic wears off I hope you have a pistol because you're probably gonna want to shoot yourself I mean this this is gonna be really really bad and they're just like ah you know you set it to where they want to shoot themselves then they always come in and say I mean they beat that they come in they're all excited and when you say it's only in the last five years I got patients all the time to say yeah you told me it was gonna last five years that was 20 years ago but where you get sued is is when you say you know the last forever and then it fails after 15 so so you got a you got a lower x-ray you you got to look them in the eyes say the price and how long it's gonna lie you can't delegate that out to the person who's not doing the procedure so impress I want you to give a letter grade so we treat three diseases perio cario and occlusal how would you say the dentist in Canada in the United States and my gosh how many how many countries and you were in UAE for what four years six years so what's the what letter grade would you give um well your your community british vancouver or dentistry in general on Guest:caries pareo and and occlusion of understanding diagnosing and treating the disease I mean curious is that's a that's a question to think because it depends on how you want to grade them right but I would say in general as a community myself included really and our profession as a whole we understand Kerry ology we understand the biology behind it we understand everything related to it we have pretty good guidelines as to how to treat it you know so we understand Kerry ology as a profession Periodontology we also have a very thorough understanding of that's probably the most researched part of Dentistry right in terms of which bacteria’s cost that sort of thing and so on when we compare Curie ology to period ontology I'd say there's probably less of an understanding when it comes to periodontitis and how to treat it just because of the I just because of the fact that there's a lot more variables involved in periodontitis and periodontal disease so there's a lot more options as to what you can do there's a lot more causes as to what possibly led to this so when you have when you have multiple different opinions you're more likely to going to have a little more confusion when it comes to that and then what takes it to a whole other level is occlusion right because with occlusion most of what we know about occlusion and TMJ and TMD or theories right there's very little actual scientific evidence and protocols about we I mean we have we have basic guidelines we know we want contact distribute equally we know we want mutually protected occlusion those are things that we have evidence for and we agree on but then when it comes to how does occlusion actually affect joint disease or how do you deal with certain occlusal factors that aren't ideal that's those are all theories right

Howard:  so  again what do we know and what's Theory what do you say there are science 

Guest:for so what we know is how things should be to have a healthy occlusal scheme to have healthy teeth to have healthy joints we know we know what the ideal is when it comes to anything outside of the ideal so when it comes to for example even even if we talk dentures so the most basic form of let's say prosthodontics which everything is based off of so dentures what sort of occlusion do you want your dentures built built into zero degree zero Degree bilaterally balanced right that's what we're all taught if you actually look at the science there's zero evidence that actually shows that bilaterally balanced in comparison to canine guidance actually does better when it comes to function actually does better when it comes to attention the evidence that's out there actually shows that there's no statistically significant difference so when it comes to occlusion there's and that's why you have you have godfathers of occlusion right you have names that are very well known an occlusion because they took the time to see all the information we have and who are those biggest names would you say who says the most waited name it I'd say today probably I would say at least on my end based on my education Dawson's early big name oh I would have said Richard before if you asked about ecology I would have mentioned his name first anybody in ecology and now 

Howard: yeah you two are you two like the godfathers of no well well he might be humble man so you can see Peter Dawson number one

Guest: ooh would you say number two I mean for me Alan Hannum he's a professor at the University of British Columbia he was my he was on my committee for my tree because I did I did my research for three years on Digital Inclusion so how does this all apply it in the virtual world when we take a look at the bite and things like that so Alan Hanham is also a very knowledgeable person when it comes to a history of occlusion the history of TMJ and TMD and how it applies in today's world and using today's technologies

Howard:  but he's only got a BDS and a PhD in FG s or C don't you have anyone with more qualifications so you'd say Dawson and Alan G Hanuman Hannah Hannah okay who else 

Guest:I don't know those were the two that I would consider my go-to for reason I can't really ask this because I'm Richard sitting right there but how come when they come out of dental school they they all claim they're confused with occlusion they don't say that about cario or Perry oh right so let me tell you all seem to be confused about occlusion is that because there's just so much unknown I went through profs training right so if anyone's supposed to learn about occlusion its prosthodontist cuz we focus on complex restorations and we we had intensive training because Alan honam's at UBC so he took on the occlusion program so the more and more you delve into occlusion the more and more you realize we don't actually know as a profession we don't know the answers to the questions and that's why people are confused because you give them theories but if you give someone a theory without actually being able to explain it thoroughly in a way that they understand they're going to be confused by it and the fact of the matter is those a lot of those theories aren't backed by hard evidence so they are just theories they are just assumptions and it's so variable that's the thing so we know that even even patients right there are some patients whose perception is so sensitive to occlusion that their perceptions more sensitive than a piece of shim stock which is around 8 microns thick they can feel something that you can't even detect with shim stock and there's other patients where you look at them and they're like my bite feels fine and then you look at it and there's a three millimeter open bite because of such a high contact so it's such a it's such a range of sensitivity among stations and that that that also makes a big difference right because depending on your patient you're going to have to delve deeper and deeper into occlusion to get it refined to a point where it's clinically acceptable for that patient

Howard:  and by the way I'm gonna I'm gonna keep answering this this on on the air but a lot of people say um why did I put a doctor in front of a name when you put DDS and tell me for English and phonetics and yeah it's always some bizarre narcissist it's like okay when you say ubc what are the Americans gonna think what are they gonna think yeah UBC University of British Columbia right but like Canada into a CA California CA these um when people say they went to UBC I mean they might be thinking of you know Buffalo they might be thinking of Birmingham they you know all they all these things like that but um in the Middle Eastern world I love how they say you can tell by the pronoun if it's a man or a woman they do that in Portugal - they go DRS a male DRA is a female but I went the reason I'm not I'm not doing it for the grammar English Nazis in America I'm trying to make it so that when Dentist around the world see a name they'll they'll know it's a doctor they don't know all the alphabets ooh bind it like the the English in the Canadians like you have a behind Hanna's name FDS RCS I mean who knows what that means you know I mean so I'm I am asking specifically about this occlusion Hill because money's the answer what's the question some occlusion protocols need tech scan machines you know $35,000 machines things like that you're a prosthodontist do you talking about digital scanners you're talking about CBC T do you have the occlusal machines like that I mean do you have a tech scan 

Guest:yeah I've used the T scan I've used it it's really it's really a good tool for especially when you do full mouth rehabs whether it's on implants or teeth and you want to get a sense of where you're at patient feels like there's something off it kind of tells you it points in the right direction the problem with the t scan though is two things one it's not specific anatomically so it'll tell you somewhere on the right posterior there's a high contact but it won't tell you anatomically morphologically where that is so it points you in the right direction the other thing is that the T scans 100 microns thick approximately which means that that thickness is going to affect what it is that you're measuring 

Howard; so if someone came out of school and they you know when you come out of school the first thing you need to do is you know you need like football you need to learn your basic tackle your basic block your basic pass your basic catch they need to go in there and do some crowns and simple endo and learn patient skills but as they start to more from 1to dentistry to quadrant dentistry to full arch dentistry and they wanted to help on their occlusion what would be the lowest hanging fruit 

Guest: so here's a good tip for for once you get into more cut more comprehensive dentistry the best way in my opinion the gold standard of checking occlusion is to take your bite registration material so any sort of PBS that's used for bite reg and take a bite record of the full arch and then put it up against a window or a light box so transillumination that's a very accurate way that's considered in at least research it's considered the gold standard of occlusion and it's very fast it's very practical it's cheap to do right and it saves you a lot of time rather than going with articulating paper which we know is not accurate depending on the material you're testing it on but a bite registration you put it up against the wind a light box and then you can see where the perforations are and you can see where the light areas of contact are based on the thickness of the material and the amount of light that you're seeing go through it plus the nice thing about that technique is it actually identifies a landmark for you so you see that that perforations on the distal aspect of my second premolar so I know that that's where I'm going to go and make my adjustments

Howard:  just to be honest keeping it honest here on dentistry and centering when when you go to Alan G Hannan's website it says right there UBC faculty dentistry noble bio care oral health center does that um I mean what is one to make of that is still obviously no bio care funded it is a hard to stay

Guest: that's the name of the dental clinic at the University of British Columbia right so I'm assuming when it was set up it was funded and sponsored by Nobel biocare and that's

Howard:  why they're on the Richard you've been on is this your fifth dental school that you're working on now something like that still midwestern sure well I was with other universities before I do still but I was starting them up yes it'll be the poor thing so I remember when Ben Johnson would go around I remember as

Guest: I was in University of Memphis when he set up the endo program he bankrolled the whole thing Tulsa and other other endow companies were up in arms you know so so um so what do you think about a dental company like no bio care sponsoring it well I remember when that happened and I was with a different school at the time and everybody was jealous UBC got five million bucks or whatever it was to fund this particular project as long as its hands off in terms of the scientific expectations and the clinical expectations you obviously expect that they will want to have their products use there as long as the faculty are free to talk about other products I I don't have a problem with them everybody knows when you see that name that there's going to be some influence from that company there's a bother you because having having been at UBC I know that we we utilize multiple implant systems so it's not like we only utilize Nobel buy care system we utilize multiple implant systems like you're saying there's no there's no direct influence into the actual didactic aspect of the education it's one of the three systems that we utilize and to me it's a I mean well it's a good segue into the question because um the 

Howard: the kids all say that um implant training they they feel like they need to pick the implant first because you know if you're out in persons Kansas and you know it's all manufacturer driven and you you run an Institute so is your Institute manufacturer driven is it more agnostic driven and what would you say to a kid who wants to start learning implants but she sees that where she lives all the all the C II is like from bio license or something or that was bought by shine or noble bio care or whatever so how do you how do you separate the how could you make her help her make a good decision on where to start learning implant training 

Guest:well the you mentioned it so there's a difference from when you go to any Institute you go to whether it's a university or a private Institute that's providing education is going to be backed by corporate partners because they provide the tools that you use they provide the materials that you use or even if you're paying for them you're choosing a system to have them practice on because you're not gonna you're not gonna run a let's say a you know a nine-day module and teach people three four different systems it'll just confuse them so you'll end up having to choose one system there's a difference though from going to a education program that's run by a company rather than a educational program that's run by an educational institute or a university that's supported by a company that's where I think the major difference is and that's actually one of the reasons why I was very excited to get involved with an with an educational institute because whether it's with implantology a lot of the a lot of the education we get in implant dentistry is company driven and that's where I think it's a problem and that's something that you know what when we run when we run our educational institute we pay a lot of attention to make sure that that is not the case so in other words on our faculty so we've around 25 faculty members at DDI the digital dentistry Institute and  they're there what is the website for that DDI dental comm DDI dental comb and so those faculty range from there they're all across Canada in the u.s. they range from you know general dentists to periodontist to prosthodontist to maxillofacial surgeons to dental technicians to denturist s-- so we have a really comprehensive team and when we come in and put a curriculum together whether it's for implant programs or our digital programs we make sure to include all the different perspectives whether someone uses you know Nobel byuk here or use a straumann or use a Zimmer whatever it is we include the actual principles involved in allowing someone to treat their patient in a certain way that's evidence-based that's you know driven by by by experience that's driven by science and then after that we choose a corporate partner that's first of all going to support our vision of being able to provide quality education and we also choose a corporate partner that we believe in or at least we have a consensus that they're going to provide a certain quality for our participants but this applies to the implant programs but it applies even more to the digital programs because we do the same thing with the digital programs right we've got to choose an intraoral scanner to train them on we have to choose one but that doesn't mean up the names we're partnered with three shape okay three shape yeah and we're partnered with nobel bike here for for our implant programs so four implants nova bikers it's that whole high cost Scandinavian thing you did Denmark okay so so you like how noble biocare so so why did you pick three shape and and Noble Biocare because first of all art like I said we have 25 faculty when we looked at what we have the most experience with and what we as a consensus think is let's say leading-edge we agreed that those two companies would provide us with first of all the support and second of all the innovation to allow us to continue to teach our participants at the standard that we wanted to provide but the point that I was trying to make was regardless of whether we using three shape or no Bell bike here our goal is that when a participant leaves after a three day program with us they're able to go to any scanning system purchase that scanner and utilize it based on just fundamental guidelines and education that they've received that's not specific to you know one company or another and it's it's it's the same thing with implant dentistry if you know the guidelines and principles of implant dentistry whether you play Snowbell implants or any other implant system it's the same fundamental as it's just a matter of understanding the armamentarium understanding the drilling protocols and that's something that a company can provide you that's information that a company sales rep can provide you with 

Howard: and tell us about your journey how did you um on DDI stands for digital dentistry Institute I love the implant thing and I was really honored to get you on here because I'm dentist reason it's an old profession I mean I'm today was the what today's a birthday of Galileo four hundred fifty six years ago he was born so you got to say something about loop sir come on it's Kelly's birthday you don't say something for his birthday but you know I'm here for sure GV black you know it's a 200 year old deal but when you look around the world cleanings exams x-rays fillings it's been growing one and a half to three and a percent a year my whole forty thirty years I've been in it the only double-digit growth is in clear aligners and implants and I know what they're chewing on waiting for you to get to on the on the scanner was if they get I Taro for a digital scanner that that's on there clear aligner deal cuz the line technology which owns Invisalign own sight arrow so a lot of the young dentists are really excited about clear aligners and  the smart ones are looking at smiles direct Club as a how did they lower their cost I mean when Southwest Airlines started lowering their costs all the other airline's took note they quit doing Mills it was most of their lowering was just direct director instead of the hub-and-spoke so that was a whole cost reduction and I've already seen the really smart ones I'm working on us looking at this saying well I don't have to see you every month you know my I mean those guys for twenty five hundred they see you one time and give you 14 trays so why don't we do that and then satisfaction equals perceptional minus expectations by the way if you need to come in and talk to me it's drop a benjamin at the door it's a hundred dollars you know just come in drop a hundred bucks and you get to see the orthodontist and all that so so back to the scanners you're with three shape what if they were kind of hybrid clear liners and plant ology what do you think of the  I tarot scanner 

Guest:I think it's a great scanner i've used the idea scanner so it's it's definitely up there when it comes to accuracy precision i tell people if you do Invisalign ITL makes a lot of sense right because of what you mentioned so the workflows a lot smoother it's integrated its it makes a lot of sense for me for example because i use a lot of i use three shapes smile design software Ardas our lab we have an in a fully digital in-house lab they use three shape software for us it makes sense to keep it within the three shape workflow so it's it's very specific to your overall workflow what it is that you want to get out of the scanner if it's just scanning any scanner scans and as long as you know that its accuracy is within the ranges that we accept and it works it's a matter of what are the other features that the scanner provides that fit into your ecosystem that your staff learn but they're not open because i hear oh and they're all open now so did they sue their way to openness so they're every scanner on the market today at least based on my understanding is now open they all allow you to export an STL file the last to do that was sarah wright they were notoriously known for being a closed system Sirona because they had the in-house milling machine that you'd purchase and they still do but they realized that things are moving in a very different way that was a limitation to a lot of people to purchase their software because no one wants to or less people want to commit now to buying a scanner and a milling machine they might be ready for a scan and if you're closed then that's a limitation for your business

Howard:  so I think the date is driven that chairside milling is not working because the or did you where you show me the time no no no I was just writing down some grammatical issue I had with Oh Richard I am it seems to say that you know when Redken discovered the radiograph dentists didn't notice it until the first dental insurance popped up for the Longshoremen's Club is right after awards he was about 40 it was about 1947 1948 the our government's best idea was to have price wages so freeze so you know it's one of those stupid things where they do it all the time they'll say Oh New York the rents too high so we're gonna freeze rent okay so that no one builds a new apartment complex for ten years and you know how's that gonna work out and so the government said after World War two price freezes and wage freezes nobody's getting a raise you know they froze all wages after the war so that's when they came back and the unions and their muscle and they're aggressive and they argued and they said okay well then give us dental benefits and they could have picked anything to get a big housing clothing cars gas whether they pick dental and when you look at this when they start of the dental benefits they covered x-rays on a percent uh all the sudden renkins like the newest guy you know renkins like my neighbor and the domino effect of buying an x-ray machine just went clear across america and so and i don't care what anybody says about radiology all historical evidence shows that when you go around the world and you go back in time when the insurance doesn't pay a hundred percent it's amazing how many less x-rays MDS and dentists need but that chairside milling come on it's been thirty years they didn't get the fifteen percent so i mean when you take about intro cameras and in fact would you see interval scanning has passed chairside milling I mean chair side milling most of the hardcore data I sees only like 12% I'm being generous rounding up to 15% but do I think do you think intro scanners has already passed your side milling I think so in terms of popularity and being in more clinics absolutely so chair chair side so cheers I'm milling it it didn't work it works for some clinics right if you if you and when when eight when when 85% don't do it I mean come on my homies they all got eight years college I mean only in Phoenix if you know the difference in a cosine and a tangent you're a dentist a physician I mean they're smart people and when 85 percent of my homies with uh you know study calculus and physics and geometry and all that stuff when eighty five percent say no all pass that's  damn significant know

Guest: for sure I  think so for our practice we have a group practice we have around six to seven because one is retiring on the verge of retiring specialists prosthodontist and periodontists and in our practice we have a lab so for example if you have a really good relationship with a lab or you have an in-house lab or you have a lab in your building or close by it doesn't make sense to have a chair sight scanner right because you can delegate that to the lab you can take the scan send it to them have an agreement with them that you know on this day patients coming in I want my restoration back the same day and you can still provide the same day service because that's the whole point of a chair side milling machine it's being able to provide same-day than a switch that 

Howard: which I'm gonna which I'm gonna call Bologna on I mean I've I worked three days last week I work on two necks I work Tuesday again for thirty two years when I tell someone oh yeah you your teeth broke you need a crown they're only question is how much is it gonna cost will my insurance pay is it gonna hurt was gonna look like I mean someone says well you know I I'll do it if I have a same day I mean that that's like that's like a once once every other year and then because you don't abused it you called your lab guy and he's like yeah I obviously do because you don't abuse it but Richard I mean I mean come on what you're when you're advising dental schools what's your advice on chair sight milling when you know that the graduates from half a dozen schools you work with eighty five percent of the graduates don't have it 

Guest:well it's it's a huge problem in dental education what to teach because of what's out there and what's coming it's a difficult issue as far as chairside million I'm going to defer to the specialist but we are in the process of setting up a new dental school in California some school yes they got you P UCSF they got Loma Linda they got UCLA USC and Western and then they got rosalind well that's in Utah that's Western Western is what cities are California Pomona Pomona yeah I lecture there in a week or two there you go so now they're gonna pull in Sacramento they are and then what do you think of that well I think it's a great location because the whole Central Valley there has a need for a dental school that will train people from that area to stay in that area hopefully and it'll

Howard:  I assume it'll be a DMD school since the last second we're all DMD I've been told they'll never be a DDS one again probably not so if that's the deal I think they need to what we're talking about earlier the initials after your name I think it's very rude to the American consumer because they see a difference in a do and a MD and they're always asking me you know what's different seeing a DDS and DMV and I tell them the truth I say a DDS is a real doctor and a DMV not no ideas too but I can prove it because if you go to Microsoft Outlook you put Howard for an DD wet DDS it recognizes the diploma it's puts it in for an , Howard but if I put DMD now it puts in my last name as DMD comma Howard for an so if Microsoft if if Bill Gates shitty software doesn't recognize your degree I think it's safe to say it's not a rotor but don't you think that's confusing – 

Guest:yeah but dentistry is really a branch of medicine let's face it it's a specialty of Medicine and why not therefore link the degree to miss I

Howard:  I completely agree and and the reason I like is because I'm when you're in the Soviet Union and you have an injury and you know I hand coordination whatever well you're an MD your stomatology she can go back to your med school do a rotation in dermatology and in JumpShip in america you like your dentists you lose one eye or one hand or whatever you can't physically do dentistry they're gonna put you all the way back to dental kindergarten to start another career and I think that um I think it's a lot better the four years undergrad the same first two years of med school the same and then after med school if you want to do dermatology ophthalmology stomatology whatever but I like the fluidity of jumping back and forth and I also think it'd be better entrance like if you came here to United States and you're a dentist from when I got here in Phoenix this this poor lady um she fled Nazi Germany and she came here and they didn't recognize her dental degree from Germany and I get it I wouldn't either I mean you know this is um this is home of Chrysler not stupid Mercedes Benz or Volvo or Porsche or you know those guys how would they know how to do dentistry making things like that and um but I thought it was um they didn't recognize her degree and she was already married and kids broke and when I met her she's about 85 she says you know was the best thing that ever happened because cuz when I heard that she go I just cried I cried and I cried and I went got a lawyer he told me there's nothing you can do it's restrictive great but what it forced me to do is she had opened up a dental office and could do the dentistry so my time I met her you know so what was the war's over 45 and I got out an 87 so those years later she had at North southeast was she had a limo she had a driver and she just drive her and so she goes um them by them taking my hands away I had to do the business and she says my hands would have faded away 20 years ago I'm 85 she goes I can't even drive I got a driver but she's driving I mean she was she was probably the richest dentist I knew other than back were you you were here when I was more copenhefer no did you ever meet Mort no remember he lived on the castle on the side he stole I know the health yeah now you never met him yeah well

Guest: I've only been in Phoenix area since 2001 

Howard: and then you were Minnesota before that University of Minnesota no mureeds yeah I'm a mater yeah and I go there all times my oldest sister's a cloister Carmelite monkey like Elmo oh you don't really kill more do so I'd have to I in there and go do four hours in one minute at Patterson 3m or Minnesota or or Mayo Clinic to make it a business trip but um but yeah I um I think the Russians do a better deal but but sure sight milling that was the question my question is you know she isn't asking she's 25 she's got $400,000 student loans do you think she should buy a $135,000 Cerrone and chairside milling to be high-end dentists high-end dentist like you

Guest: I don't do chair side milling I don't do same-day dentistry myself but unless that's your goal and that's that's your business plan is to provide that service and market that service because there's people who build out their practice based off nothing the answer is no but do you really see it you really I mean can you give me a name of a dentist who's just like all that a bag of chips from same day dentistry I  have his face in my mind but I don't remember his name he's  based I think in New York he's yeah well New York's a largest city people fly into New York specifically or people fly into New York specifically to see him not just because they wanted same-day obviously because why would they fly for same-day Dentistry but he's taken it to a point where he can do same-day dentistry to a certain quality that is superb but to answer your question I don't think it's if if I were to categorize the technologies you could invest in starting out a milling machine would not be okay I like the way you're going so start so tell me the top three in total scanner okay intro scanner and and here I'm going to say three shape because that that's what you use I mean you said met it was a like I said I T Rose a good one if you plan on utilizing Invisalign prime scan is a very good scanner that's  new scanner Sirona though those are those are some those that probably the top floor in my honor because he's married now a married DENTSPLY yeah dense place throw now and how do you think that emerges going with a new product it's interesting because they've been able to they I mean I'm sure there's more integration to come but the fact that they've been able to integrate their you know sirak branch to speak with for example simplon to speak with atlantis so they have a variety of different services and if they're able to integrate them in a way that's practical to use and I think that's a very powerful thing okay 

Howard:so first was intro scanner yeah and you recommended three shape yeah and you give it some other names okay so what would be what would be next next would be

Guest: I would say a if you are a if you're going to focus on implant dentistry in your practice and that's an if so it's not if you're placing a couple implants a month but if you plan on doing it day to day as CB CT is definitely worth the investment name brands they I honestly don't think that at this stage given how far they've come that there's a difference I mean you take a look at a few things take a look at the field of view and make sure that it fits what you're doing so for example if you're using a CBC t4 endodontic purposes you need something with a small field of view if you're doing more comprehensive cases you'll want a larger field of view take a look at the resolution of that scanner and then focusing on those two points see which one has the most radiation that's supplied to the patient that's how I would judge a CB CT scanner plus see how it integrates with other systems that you have but I mean so so we have we have a cable scanner it's it's a Nikon scanner do you sorry dude what do you it's funny how we live that cuz you're benching Sirona 

Howard: so when I get out of school Siemens was like the largest company holding company in Europe can like Johnson Johnson and Gillette and all those kind of things and some CEO decided they were over weighted in healthcare so they spun off Sirona but the building was still there in Austria didn't move across the street it's the same people you see it all the time and and now we have Danaher which just took their entire dental division and said yeah we're just gonna spin it all off and called Invista cuz you just mentioned that cave oh um nobel bike here yeah no Biocare and and they own implant strike but i just want to tell you this is what I saw with Sirona I mean imagine if your mom didn't love you and I mean can you imagine that I had dinner with my mother last night I couldn't imagine that and when they spun off when Siemens Smirnoff cave oh oh the the Austrians were like yeah they were all copying and they were free and the parents were gone and they started this whole storm and I Isee the same thing at dinner I am you know no one will come on the podcast I tried to get the CEO to come on and no luck yet but basically my friends that have been in those companies forever they're like hey they don't want us great there goes all your regulation so now it's gonna be a bunch of free guys to go innovate so if they pull a Sirona I'm looking for exciting things from Invista who do you think they'd go with what do you mean like what do you mean by Pulis aronia well well well Danaher owned well here let me let me pull it up what is uh what is his name a mirror yeah it's a mirror how would you say that okay so so they you know so Danaher owned gen decks arm kono biocare cable kur implants Dirac site brawn dental all this stuff like that Oris kumtak and they they Danaher said we we don't want dental anymore so they packaged that all up and sold it to Wall Street and guaranteed the stock price for a little while or whatever and they're all past all that and and so now Amir is a president CEO of and I love the name Invista but basically it's just like Siemens saying we didn't want to get in dentistry they spun all Sirona and so I think I think when they're spun off and you don't have a mommy or daringly that yeah it's all kinds of bureaucracy and regulation and if you if you're gonna try to come out with a feature you got to show that what we're gonna give you $1 retained earnings we need our dollar back in a year with this much and and I I think they're free and whenever I've seen this a bunch of projects that have been been killed by bureaucracy because they want to give another penny per stock to Wall Street I i I've always seen him get really excited and do a lot of great things I mean it's mainly Siemens but I I think in Bista I mean those are great companies I mean I mean gosh Lord warm Co noble Biocare I mean those are so many great companies so I'm I'm I'm on so many tangents over from this comber this aw podcast I don't even know what we're talking about right now but I'm so back but back to the the CBT scanner any name brands 

Guest:Oh like I said I think it's more the features and the name brands I can tell you what we use which is the cable Kerr I cable car they use I guess you know and 

Howard: I use Carestream because I I was on soft and for 30 years until I switched to open dental and there was a caroms owned by Kodak so I have the character do you like that one yeah yeah good okay so intro scanner CB CT what's

Guest: next I would say a 3d printer really Wow and tell us more a 3d printer in my humble opinion 3d printing will over no one but anyway a 3d printer yeah because of because of the fact that 3d printing will overtake milling that's that's that's just common sense it's common sense because like see we're gonna do a gold crown you'd have a big block of gold yeah I mean we do meal gold and then we gather it all up and melt it again and reuse it so it's possible to use without wasting the material but if you're talking about things like zirconia or whatever it is first of all a 3d printer can do a lot more complex designs than a milling machine can ever do because it's limited by you know how many accesses you're using you're using certain tools and equipment Spurs to to subtract whereas with an additive technique which is 3d printing you can design really complex structures and again sometimes I feel like we in dentistry don't think of the fact that a lot of this comes from other industries so this is something that we've seen in so many other industries where they've really moved towards additive manufacturing with 3d printing though if that's additive manufacturing what would what would you call that milling is subtractive milling and subtractive milling is subtractive technology which means you're removing material to create something 3d printing is additive technology because you're adding either layer by layer or adding particle by particle to 3d print an object so 3d printing is you can do a lot more complex things than you can with the milling machine it's it saves a lot of material and it's the only barrier to entry has been cost but it's been very very expensive to get a 3d printer but that's no longer the case right for su brands I mean formlabs 2 is probably the most popular 3d printer that there is in dentistry right now and labs - for for maps well there they actually just released a couple weeks ago or something recent because formlabs 1 or 2 their printers were not dental specific they were actually 3d printers that were used in any industry right they'd print toys with them they'd print parts for shoes with them so they weren't actually dental specific there were dental specific resins that were utilized so you can use them in the mouth more recently they released I think they call it the formlabs dental printer or something like that so it's specific to dentistry and that's just more the functionality the user interface and things like that so you gotta have to Boston seen this or we have a couple formlabs two printers in our clinic and then and then carbons taking the market again by storm when it comes to at least people talking about it and things like that because which one carbon it is yeah it's a really fast printer because the formlabs is affordable I think you can purchase a form lamps for four thousand five thousand dollars a carbon printers you know closer to a hundred thousand so huge difference but the the main advantage of a carbon is it's very very precise but it's also very fast so what would take you around four to five hours to print using a formlabs printer you could probably do in less than an hour and a quart with a carbon printer so if you're a lab if you're a dental lab that's running a printer 24 hours it makes a lot of sense for you to invest in a carbon printer rather than a formlabs printer so

Howard: so form Labs is a tad Germany where's um where's carbon labs out of I'm actually not sure it might be here might be in the US is it yes Germany I'm not sure um Carbon is let's see Wow interesting so you like that one yeah that's 

Guest:that's a very good printer it's very fast and accurate printer it's only like I said obstacle was price point it's very expensive and what are you printing you mean in terms of what we like materials or surgical guides night guards retainers we can now print dentures so whether those dentures are used as complete dentures or they're used for an implant restoration in plant retained or implant supported restoration we can print metal 

Howard: now there's a big denture printer here what is it Africa evident evident yeah so they milled their dentures I believe oh they're milling they male okay so so you're doing you're using a 3d formlabs printer additive technique for surgical guides temporaries dentures

Guest: yep we don't do them no not in our practice but carbon/carbon actually just very recently partnered with DENTSPLY to fabricate dentures so carbon prints don't apply utilizes their materials and technologies for this glass example of something that's bleeding-edge not the time to buy invest and while they're working out all this i overhead stop yeah no not unless you're a lab like i said if you're a lab that produces enough where it makes sense for you like you'll you'll pay it off just because of how fast it'll be compared to you running three or four other printers that are running much slower so in terms of productivity it does make sense and carbons the printer I was telling you about that started the subscription or lease model so again they're trying to get rid of that obstacle

Howard: so it's just a better modern log you see some examples why when I'm out here in our backyard there was a company called smart practice for Jim Naomi Road and they there was a lot of back in the day there's a lot of software companies and confidant --ax was the only one where they came out they said it's just hundred bucks a month and remember when I asked 187 there were companies selling lasers for 50 thousand when was that India Glaser for 50 thousand and after they sold 1000 at $50,000 PC I went bankrupt and everybody was saying well how do you sell a thousand boxes for 50 grand go bankrupt because it's cash flow they never knew what they were gonna do and all the other software companies they're always adding programmers laying off it's always feast or famine and when that confidant extorted his name was Tom he was up in Cottonwood or somewhere up there he said man I just want a hundred bucks money he goes I'm up to a thousand dentist I had a thousand dentists give me a hundred bucks a month and so you can budget everything so when your Netflix and your Spotify and you know how much monthly revenue you get on well you can plant in fact that was the whole story of um you remember the story of Proctor and Gamble in the eighteen hundreds of how that became such a big company you remember that one um you know people would go out on the ranch they'd make just a boatload of soap and they'd load up their whole horse and buggy and they'd go through towns and they'd tell you this gunnysack of soap and you would buy the soap hell you got a lifetime supply and after they sold all that soap they had no customers and Procter gamble was watching these bankruptcies because you know if you got a statement of cash flow which no one reads you got a balance sheet which you'll you'll read when you get divorced and then you have a profit loss which you know when the mob once paid every year you know I love the American mob the IRS they say it's time to pay taxes you say well how much I owe I don't know but if you get it wrong go go to jail oh that's that what a class act and and Procter & Gamble's setup you know what we're gonna do we're gonna reduce everything bar soap - but you've paid everything - you'll use it in a month because I pay my bills monthly I pay my rent monthly I pay my employees monthly rent mortgage equipment build a computer engine all your bills are paid monthly so when they got it down to a monthly user and then they could go to the banks in Ohio and say here's my monthly cash flow and those banks that say well Wallonia millions of dollars and there was Proctor and Gamble and so these these people that sell a say a form lab printer well how do you know what to sell it for because if you ever run a 90 or 120 day area with no sales you're all gone and and I can tell you that nobody can predict the stock market and anybody says they can is a complete crazy but Richard and I remember 1980 we remember 1987 Black Monday we remember March 2000 the y2k ba-bop time we remember Lehman's day so I've lived through four contractions and every time there's a contraction all these people that are selling high-end products they go out of business and the people that have the subscription revenue model it works so it it's just a better model and that's why at a tiny Netflix was almost worth more than Disney hears Disney with Disneyland Disneyworld they got you know you've been to them your mom's been everybody's been to the Mickey Mouse gardens they got cruise ships and all that stuff but you know they'll release a big movie and they'll put a hundred million dollars that movie in there wasn't 300 million back but what if they release on a million dollar movie they only get a hundred million back so so yeah so I think that anybody who's selling over anything for 50 to $100,000 should go to the subscription model and I also think my kids I mean I mean I don't know how old this smartphone is my grandkids always ask me what kind of is but um no one's gonna keep anything high-tech for more than five years so it'd be really I would be much more inclined to buy any this stuff if after five years I could call up Carestream and have an agreed upon they'll pick it up and I'll give it's like every time I take my car in for an oil change you always say well if you leave your car here and write me a check for this amount you can have the brand-new one and so on it's a better business model so okay so your so so you said oral scanner 3d and now you're doing 3d printing 3d printing

Guest:  and CT scanner if you're into implant dentistry and and then the other the other thing that I think really everyone can utilize and you don't really need to invest much into this is smile design and again if you're if you're doing mostly you know day to day restorations and maybe it's not right for you but if you do any sort of cases that have a cosmetic component to them you know whether it's dentures or whether it's you know aesthetic dentistry whether you're doing an through your crowns starting to integrate virtual smile design into your practice is a huge is a huge game changer when it comes to communication with patients and that can be as simple as taking a photograph putting it on PowerPoint or keynote and having a pre premade template where you're able to overlay things and show them to your patient so I always go back to the same two points predictability communication that's that's what digital technology is allowing us to do and for any you know newer dentist who is getting into things you don't have to invest money into starting to utilize this technology it's just learning how to utilize it that's the thing because it's a double-edged sword 

Howard: so what is what are my homies most excited by at your DDI its DDI dental comm for digital dentistry institute comm first of all the programs are all over the world right you don't have to go to Vancouver yeah no we've got programs running in multiple cities in Canada we've got them running in San Francisco Houston Atlanta were in Dubai were in the UK we're in Malaysia were in India were in Australia so oh yeah and and that's t the real you know basically it's

Howard:  okay so you say core programs digital programs live surgery programs but what are your what are your what would is what's hot I mean what what classes are filling out way you're spreading around the world it's either you're the hardest working man in dentistry or you got a product that someone wants

Guest: yeah so it's the implant programs are actually you I think you had on your podcast dr. Bobby birdy and dr. Sandeep Rawal absolutely they're  the they're two of the three co-founders of the digital dentistry Institute and I work with Bobby in Vancouver we work together so when they put this all together they actually brought onboard what was called the Pacific Institute for a Pacific Institute of implant training or something like that it was run by Dr. Ahn's oh cool for 25 years or so where they provided implant training for dentists all across Canada and in some in some cases the US and so our implant training programs have been around for a long time and we all know what implant training programs are involved right you have the didactic component you have the component where you're actually practicing on models or big cause or the didactic 

Howard: that's just the the reading and stuff yeah that's the lecture that this principal is the one you should put online on dental town because they we've put up 400 courses and they've been viewed over a million times that's crazy because you're you know they just like to take an hour increment on their iPad and and then the hands-on things but I think it'd be a great marketing for you and no absolutely

Guest:  that's online education something we're very excited about and we like our plan is to 100% get into that because it doesn't make sense in today's world for us to still be asking people to gather in a room to hear someone talk when they could be doing that from there office from their couch you know so we know that online education it's a multi-billion dollar business now and and it's it does better for people right it's better for people to be able to go at their own pace to take that course from their own 

Howard: it's just better education because I've seen a lot of this online research that's coming in I mean like little kids in the morning they're sleepy they're not even listening to like 10 o'clock you're at a lecture and you get texted or page you're gotta go to the bathroom or you're hungry or sleepy I mean they have shorter attention spans and anybody wants to recognize and at one hour course you can put it on hold you can go to so I think it's better deliver it's faster it's easier it's higher quality it's lower cost 

Guest:the challenge with online education when comes to dentistry though is you know we run we run our programs usually in three day modules on each day we'll have a hands-on component where they get to take in the information and then actually apply it even if it's on a model and that makes a huge difference in how you retain that information so what we're looking at is how are we going to be able to utilize online education but not give up on the hands-on component so you know that's where we look into things like virtual reality or things where you're able to 

Howard: what do you think of the ABA changing their cert program where they're not gonna give it to manufacturers so like no biocare they sell an implant you're not gonna get you know you know every of you where this change my do

Guest: you mean they won't keep it to corporate so if they if an implant company is running a seee program they won't give them seee accreditation right that's what the talk is now personally I think that's a good idea cuz I think what's lacking when it comes to education and this more applies less to implant dentistry more to digital dentistry so much of the information that's provided on digital dentistry is coming from companies I'd say 95%

Howard:  oh my gosh I mean it's easy because every time someone invites me to speak they go well well who your sponsors no one well what company will pay Your Honor I'm no one and and and you it's the it's the same speakers at all these meetings and I've been saying for 30 years you got to dress up as a NASCAR I mean I don't care my favorite driver says Standard Oil or Pennzoil or whatever just just come up there and wear your damn NASCAR uniform because because it's called transparency and they're not transparent and these big meetings are it's crazy because when you're trying to manufacture this oh man we got we bought someone's booth space we got to pick five speakers it's like we'll say that on my show see it on the show I mean that because the young kids don't realize so in some and then when you're as old as me and Richard I mean how many speakers can you name that would only um mention this product for five years and then on a dime they switch to another one and five year later it's a dime and another one I don't care what you're doing I don't know walking your Mausam but it's called transference you just just say it and that

Guest: that's what I'm most excited about what we're doing with DDI we have based on what I know the only or the most comprehensive digital education program that exists in today's dental market and it's it's the only one that I'm aware of that's as comprehensive as ours where we cover everything from intraoral scanning to virtual smile design to 3d printing to CAD cam to milling to implant planning to 3d guided surgery and all of it is education that's put together based on the actual fundamental evidence in science rather than this is what the company says these are the buttons that you should press on the laptop or a computer it's why are we actually doing this what are the different techniques that you can utilize tips and tricks because if you talk to if you talk to people who purchase a scanner or purchase certain software a lot of them will end up putting it in a corner where it gathers dust and that's because either they try to do their first case and it doesn't work out and they're like nah I'm going back to PBS I know how to use that and this doesn't work but there's a learning curve but second of all they don't get the right education as to how to use that software how to use that product and that's that's what we're trying to change its how can you understand the fundamentals behind an intraoral scanner so that whether you end up buying a three shape scanner or end up buying an IT arrow scanner you're going to know how to use it because you understand the principles behind what it is that's happening so it's it's mostly implant so I mean the digital dentistry digital series of programs are broken up into modules and some of those modules contain implants so how to plan implants guided surgery whether it's single tooth full arch but then we also have modules that are unrelated to implants so digital a as we call it is focused on intraoral scanning virtual smile design 3d printing and how to do CAD cam so how to design restorations and send them to a lab or design restorations and send them to a milling machine and then we have our digital D program that's purely focused on digital dentures so how can you transition into digital dentures as opposed to your conventional five six appointment traditional denture which a lot of people 

Howard: so when I was when I was your age when I got out of school on 87 they told us dentures were this close to going to extinction mhm and here 32 years later the United States has more dentures in 2020 they did in 1987 mm-hmm they're not going away are they no and that 

Guest:we've got a we've got a course focused on digital dentures nothing else because of exactly what you're saying they're not going anywhere and digital technology is going to take away in my opinion which was the deterrent for dentists to fabricate dentures which is if you're running a clinic in some aspects you're also running a business and fabricating dentures is very hard for you to justify the ROI right in terms of time in terms of the complications and so on but it's the service that a lot of people need more than anything else right because some when someone comes in meeting dentures that means that they need they need that certainly it's the it's the UH I know I 

Howard: were at a time but it's the biggest bait-and-switch thing in the world I mean when my buddies that do four or five million dollars a year in implants they all started they they into an area and they found the biggest brand-name denture world and sometimes it was in a little trailer in Apache Junction but every elderly person knew you could go down there and they had a lab in a house and and you could wait and they would go get their diplomat in a International Congress or Oakland ology or the fellowship and the something and they would come back they'd buy that and they all they advertised and they still do you know like you know complete set of dentures for you know three eighty five but then when you come in there they say okay that that's the standard but you know I've éclairs got some prettier teeth and that one's a couple hundred more and then a couple hundred more to implants and a couple more and and they all do you know they'll they'll get a hundred people in for that low-cost fee denture but they'll do an on for every week and so it's just a matter of upgrading you know you you sell the lote you advertise a low-cost and then when they come in you upgrade them to to more and more and I I mean I know it got the guy who did this Bakersfield here my backyard Florida South Carolina I mean back in the day that was the best business strategy to go in fact if I was a high-end process honest like you in Vancouver and there was just some low-income denture world or whatever my god I'd buy that in three seconds because that's all the people and that's also why Invisalign is taken off around the world so much long with implants because when you go to Malaysia Vietnam Cambodia so many of these countries were the government is doing the Bernie Sanders socialized medicine thing they don't have enough money to do the cleaning exams x-ray something it's it's a big mill but if they can upgrade one person in that big pool that they're breaking even to losing money doing below-average dentistry they can upgrade one person to an Invisalign case a month their high-end or one person to an implant like when you go to Japan and London and Tokyo three of the Tokyo London and Paris three of the greatest civilizations around right I mean it's not as good as Copenhagen where three shape is but or Helsinki where my clan mech is but I mean right up there that the  government socialized program gives you $100 us for ammo so you know but they're polite people they're not gonna say anything and Tokyo though it'll take you something to drink and sock you at the bar but yeah they didn't diagnose a root canal they said well that needs to be extracted because when Bernie Sanders says that you can only do a root canal for $100 then they extract the tooth and they place a $1500 implant at 1,500 I mean hello you're in Tokyo where the land is a million dollars a square meter I mean I did I did life podcast from Tokyo London about this question and they were selling a they go dude were in Paris France you think we do all our work now for a hundred bucks us I mean how out of your mind how disconnected from reality are you and that's why I'm scared about socialized medicine because I only know dentistry I don't know dermatology and I don't know heart lungs livers eyes or whatever but in my little narrow world the socialized medicine plans for dentistry or they're insane I mean they're ins and I'm crazy but anyway so that's another reason why implants and clear aligners are both the only areas growing double-digit is because the insurance schemes whether they be private or public aren't aren't fixing the price of that but as soon as you go in there and fix wages you'll get all this game theory as soon as you go in there and fix apartment you know rent freezes I can Manhattan those two to the about every 20 years you have to go back and stick their tongue in that light socket and they'll have to relearn these lessons the hard ways but the only things growing in dentistry is we're a third party doesn't set the limit and  I don't know I'm I don't know why they do that but uh so we wouldn't was supposed to an hour we just passed an hour and a half so what's your big clothes and I'm telling him I said you  is it's kind of tough it if I was a young kid $400,000 in debt I don't like this um Superman dentistry thing because in 1900 healthcare was not even 1% of GDP and there was no specialties by the end of the century it was 14% of GDP in the physicians had 50 specialties and Dennis had 9 now it's 20/20 we're looking at health care 17% of GDP and when people say that it's too high and it's got to come back down it's insane Milton Friedman used to call it a little blue pill do you know are you married with kids genius how many grandkids are you up to 7 oh my gosh I guess I'm under the table so so but the bottom line you go to any  grandma or grandpa you go up to anybody in the world and you see the little three-year-old granddaughter and you say yeah he's got a horrible disease and what would you give me you know the little blue pill she takes a little blue pill she's fine she didn't take the little blue pill she dies tonight what would every grandpa how much would they pay for that blue pill yeah would they give you their house no one says we spend too much money on housing no one's out there saying oh yeah vote for me we'll have nationalized housing we're gonna build big houses and you all live there every single mother says take my house my car my cell phone take anything I've got to say my baby and then you look at the cost it's gone from 1 percent to 17 percent cuz it's the ultimate luxury item the only wealth is health once you die I don't how many pounds of gold you have I look for health care to pass 1/3 of expenditure I mean imagine a thousand years now when everything's made better when you're born you get great grandma's house nothing wrong with it everything's solar off the grid you know every everything's high-tech and you don't have to do anything and then you walk into the kitchen to go grab a beer and you and your eyeball falls out how much of that inherited wealth would you give back to get your eyeball back so so it's the ultimate luxury item it's like it's like I love it that people are woke to the environment and the only people worried about clean air and clean water or rich people during World War two when you're worried about you know losing your country and I remember Jack Walsh was sitting on the dealer saying well why did GE dump this in the river they're like okay first of all it was during World War two and we asked the president and the Pentagon and nobody cared what did they care about they cared about Nazi Germany and Imperial Japan no one cared about a river and then 50 years later you know with no wars and all that said now it's a rich world problem to take care about clean air and clean water and all that kind of stuff but I think that I'm I think that health care is the the ultimate luxury and it's gonna keep going higher and higher and higher and higher and higher because people are gonna find out that what they really don't want to do is die I mean you sir you'll sell them go to a funeral or the guy next to you says look at that lucky guy I wish I was in that pine box you know I mean a hundred billion humans have died and the eight billion living humans know that they're in a better place than a hundred billion dead ones and they're gonna keep driving up the cost that the and the marginal games and the first people that caught on to that was then the Mayo brothers have where you were from the Mayo brothers couldn't figure it out because at that time when you're 80 year old grandmother came in and she had cancer and everything well she's 80 years old I mean they didn't tear to the vet and put her down but it's pretty much what they did well she's 80 and the Mayo brothers like my god they're  willing to sell the family farm and pay whatever it costs to keep an 80 year old lady alive I know that that's that's where it's at and my god I would I would give both livers I'm Irish so I got at least three you know III you do anything for your kids are your grandkids and that's the way it's gonna go and anybody who sits there and says they're gonna manage it they're gonna manage the care well they they haven't they're not business people you talk to your business view that mom will throw away her car her house in fact what's amazing in downturns they walk away from their home the only thing you don't walk away from is their car payment in their phone they're like hey give me my iPhone and my car and I'll go drive away and live with my sister so they'll walk away from a home and when that baby's sick they'll walk away from everything for that baby so um so I recommend to the young kids that you can't do it all I mean if you think you're gonna sit there be master endo pediatric dentistry silvered I mean fluoride implants bone grafting sinus lifts while you're doing Invisalign and veneers and ortho tracings as this Superman doctor there's no data for that all the data shows in business from from Adam Smith a 32 year old Scottie wrote in 1776 the wealth of nations of specialization and specialization has gotta solve this I mean everything you're talking about is not just dentistry but just one part of dentistry you probably don't know anything about making this microphone or this laptop computer or tiling a bathroom so it's gonna go to really high specialist I hear these kids saying well I want to learn endo and implants and Invisalign and silver diamine fluoride and veneers and cosmetics and and I'm okay so basically so 10 specialties are a joke to you I mean would you want to go to a doctor who was doing ten different specialties so so I think the easiest one to decide is it's gonna be soft and pretty or blood and guts and I like the blood and guts I like the implants the surgeries the extractions the people who make the most money Zoar your oral surgeons and your periodontist and your implant ologist I'm orthodontist don't even make over 300 in fact I'll show you the exact difference and then the second thing is I would go into something where you know your your good buddy Bernie hasn't set the fee on that because he'll set the fee he'll get elected and then he'll just ruin an entire industry and that's fine but I'll show you the the numbers well let me show you different scene the ten specialties I've seen that prosthodontics wasn't so good on that list yeah it's um it's um it's because the the real wealth I mean is blood so or average oral maxillofacial surgeon for 48 Perry Oh 330 endo 307 pediatric dentist 304 once you drop below that ortho 289 prosthodontist 219 and I feel sorry for you because what we'll end it on this um the bottom line with pro sauce is channel conflict I have so many process on us who are in that 219 area that say I can make 100 more but if I start placing implants then the periodontist and the oral surgeons are gonna refer me cases so they can't place implants same thing with Adonis and Adonis want to start out saying well you know what I think I'm halfway through this root canal it's no good that this retreat that's whose crack I'm just gonna extract and place an implant but that they're looking over their shoulder thinking how many referrals are gonna start you know that are making money doing implants you're gonna and kill them so are you surgically placing 

Guest:no but we do surgically place in our practice it's just places impairing oral surgeon straight honest and and who places them better periodontist oral surgeons depends on your training but I think I honestly think a prost I think a restorative ly trained dentist where at least there was a dentist who understands the restorative aspects will place implants better than anyone else whether it's a surgeon or a periodontist or a prosthodontist ethically driven implant dentistry is always better than surgically driven implant dentistry 

Howard: let me give you the dark history of when Miranda mark came over here and started teaching I implants he would only teach him to oral surgeons and a lot of my friends who own some of the biggest labs in the world listen to these lectures and decided they weren't going to restore implants at their lab because the the oral surgeon replaced them and they're pointing every which way it was a business issue we're not gonna do it it wasn't until Perry Donna started doing crown down techniques that your major labs like Gladwell Gladwell when the oral surgeons were teaching implants Jim Gladwell said this is crazy we're not even if we're not gonna do it so it wasn't until it was on ground now by the way you know brand marks is an orthopedic surgeon in San Fran he we need get him on the show on what a legend but uh so um so yeah so here's my advice you got $400,000 of student loans because guys like Richard set up seven dental schools or all of them hundred thousand dollar fees that is that like your business model you just set up a school it's a hundred a year I'm just a hired help his I know so it's a hundred a year so when you get out you need to you need to pick an area that's not someone else doesn't set your price and the people who want to set their price in healthcare I mean imagine if they would have done that for cars thirty years ago we didn't have airbags anti-lock brakes housing I mean if you even want some low-hanging fruit why don't you go do all that nationalized socialized stuff why don't you do it to your house and your car and by the way you'll say oh well my friends in Canada like it yeah they like it because 99% of the population didn't spend the night in the hospital last year were you in the hospital last year for an overnight no were you yep and so the bottom line with 99% of the people don't spend the night in the hospital how do they know better but if you turn it around on them said well if we if we manage your housing and your transportation and your cell phone and your clothing any other thing they wouldn't do it for a second they'll do it for a healthcare because it's not transparent it's  not opaque it's very insane and crazy no I know Seth but I'm any any final words

Guest: no this was great I think the only thing I had is your is your audience demographics wise are they more starting off in their career midway through the career I would we'll send me an email 

Howard: send me an email Howard at dental town comm leave the comments in the YouTube I love reading the comments in the YouTube but about a quarter of them are still in dental school and the rest are all under 30 and you're either under yeah yeah I mean I get one email a month that says dude I'm as old as you all the other ones are I graduated in you know two years ago one year ago three years ago and then they well I mean do you have snapchat on your phone no have you ever be honest have you ever listened to a podcast no yeah my friends if I put a gun to their head and said pull up my podcast on iTunes I'd have to shoot my own mom no nobody in fact I tell Dennis when they you know III half my friends still have them an AOL email nothing says erectile-dysfunction like AOL email I mean why don't you just you know but yeah it's so it's it's a young kid behavior snapchat all that stuff podcast

Guest: so what I would say is we're on a verge in the dental profession where we are utilizing technology in a way that's not only going to make things more efficient so what I always tell people is forget all these selling that you hear from companies that tell you it's gonna be faster it's going to be cheaper it's going to be it's gonna take its gonna allow you to take shortcuts that's not in my opinion anything close to what the advantages of digital technology are there more going to allow us to more predictably treat our patients better and also be able to communicate with them better so if we're if we're on the start of this and you're a younger dentist so you plan on practicing for another 15 20 30 years it only makes sense for you to be involved in this transition rather than trying to rather than trying to catch up in five years because that's that's what happens all the time right and it's the same thing with technology it's the same thing except even harder with technology because of how fast it changes but once you understand the fundamental principles of digital technology in dentistry today it's going to be a lot easier for us to utilize that to better treat our patients but then it's also going to be a lot easier for us to help advance it in a way where it's not driven by companies but rather driven by healthcare providers to ultimately use this technology to better treat our patients and that's that's something that I really care about because do you believe in evidence-based dentistry right we all is dentists believe in evidence-based dentistry what I'll tell you is evidence-based dentistry is going to be thrown out the window when it comes to digital technology being implemented in dentistry because there's no way our model of evidence-based dentistry can keep up with technology like you said I called this an old phone and it's two years old and in those two years I probably upgraded it six times in terms of its software and it's gonna be the exact same things with any of the technologies we use to treat our patients so if we're trying to make decisions based on the older model of how do I change the way I practice to treat my patients using systematic reviews and randomized control trials we're going to be left behind but at the same time we can't have that transition go completely to what I read on a website or what someone who's trying to sell me a product tells me so I think it's important for my generation of dentists to really educate yourself on these tools that you're going to be utilizing for the rest of your career in one form or another and then make sure that you input your input give your say as to how this technology should advance to ultimately better treat our patients and better our profession I assume is some beer drinking contests so I can't proof because that's that's what we call them at the University of Sharjah but prof. Richard is by far the person who has influenced my career as a dentist but also my myself as a person from anyone outside of my parents because of how he's really instilled in us ethics and morals and you know you're not you're not dealing with it's not it's not all about yourself but it's more about giving back so I'm just here to see him there's there's nothing else just to see him and spend time with him because he's he's if he's influenced my life in more ways than I can share but he's really a great person and anyone who knows him agrees I've got to say as an old teacher how amazed it is to sit across the table from someone who graduated from dental school five years ago and to hear what we've heard over the last two hours which were probably an hour more than you were expecting what a brilliant young man this is the future of our profession and I'm so happy to be a part of it thank you let me tell you I I I'm on I'm on social media I have I've a lot of people who follow me and you know if you're if you're trying to communicate with people on social media you want them to engage with you right so I put out stuff hoping that will interest them add value to them get their responses the thing that I got the most responses from ever was adding to my story today I'm going to air I'm gonna Arizona to visit prof. Richard literally hundreds of people messaged me saying what you're gonna see him please say hi please say hi please tell them if we miss them so it's I mean I also I also mentioned that I'm seeing you so I don't know maybe maybe they confuse the two I dunno 

Howard: I think that's so cool when teachers connect everybody who's a dentist can go back to just a couple instructors yeah mine was in high school it actually you know it's really neat when a teacher constructs and and you know a lot of people always say that you know you know the kids mo nails are like well they want to do something with  purpose say dude we all have the same purpose in the last fifty thousand years a hundred and ten billion humans did their job and got us here in the present and the only purpose you have is knowledge has no value if it's not transferable to your replacements so every one of the eight billion people alive today are going to be dead as it as the last hundred and ten billion and the only value is that we leave them a present and  I enjoyed being born when they had streets and electricity and all the things that you know made it amazing and I never in a million years would have seen the cellphone coming the internet the laptop the computer on like I said but last night I had dinner with my mom and my four boys have turned into six grandkids I know you're at seven I know I'm gonna I'm gonna call him up today and and but you know you look at those that my one-year-old little Jasper that that's your purpose you know bottom line and if you don't want to have a doesn't matter in the in the the the planet drops 300,000 newborn babies a day 150,000 dropped dead one out of three don't even die of disease only two out of three people die disease the other one-third dies of you know accidents car wrecks or violence whatever but uh I think the I think they're heard is amazing I mean look at almost sapien I mean there's only like a dozen animals that ever lived over a hundred years check that off we're in there with the tortoise the turtle and a couple of fish we're at eight billion in number I mean in fact when you look at just the mass we're right in between like termites and beetles I mean sapien is doing good when people say there's a health care crisis like okay you know in 1800 there were two billion people now there's eight billion people I'm imagine going to our rancher and saying there's four times as many cattle now on your pasture and they're dropping 300,000 calves today I mean we don't have a health care crisis we don't have an opioid crisis I add the opiate that's the dumbest one I've heard 324 million a million Americans fifty thousand died from opioids when the British landed in Hong Kong they said one third of the whole country was stoned on opium well I'm sorry is one third of Canada stoned on opium you know everything's exaggerated we don't have a health care crisis we don't have an opiate crisis where I mean when you're part of a herd of cows that's dropping 300,000 newborn babies a day I mean Tom named another species that can beat that I mean I I think we're doing great I think dentistry is doing great it'll always be two steps forward one step back but when I go in those dental schools or when we do some of these missionary trips where I've been in like Tanzania or Mexico and you're sitting around with like six or seven of these students and they're all I can they're all like good-looking smart sharp intense ethical and I always look at him and think you guys are better than us I mean I go back to my dental school drinking buddies I mean we we uh I mean I mean yeah I think this profession is in great shape and you totally epitomize that thanks for joining our telling me and thanks for replacing me and Richard someday 

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