Dentistry Uncensored with Howard Farran
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1367 Dr. Brian Gray on Clear Aligners and Occlusion : Dentistry Uncensored with Howard Farran

1367 Dr. Brian Gray on Clear Aligners and Occlusion : Dentistry Uncensored with Howard Farran

3/3/2020 11:30:00 AM   |   Comments: 0   |   Views: 56
Since 1994, Dr. Brian Gray has shared his knowledge in cosmetic dentistry with both didactic and hands-on courses. A number of dental manufacturers and non-profit clinical research facilities rely on his input for product research, evaluation and development. National networks and magazines regularly seek his advice on cosmetic dental issues. Dr. Gray is published in numerous journals and has trained more than 23,000 doctors how to provide excellent outcomes with the Invisalign® system. He is a Master in the Academy of General Dentistry and a Fellow in five other academies. Dr. Gray has a passion for dentistry and the new advances that have made it the best profession in healthcare.


VIDEO - DUwHF #1367 - Brian Gray


AUDIO - DUwHF #1367 - Brian Gray


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Howard: it is just a huge honor for me today to be podcast interviewing Dr. Brian Gray DDS, MAGD his forte is aesthetic reconstruction with an emphasis on cosmetic ceramic restorations he graduated from Georgetown University School of Dentistry in 1986 I'm not gonna bring it up that they closed it the year later and I don't know if that was because of you or your buddy some sounds like you guys got into some big trouble and when he participated in the first international dental student exchange program and completed an externship at Trinity College in Dublin Ireland dr. gray received his undergraduate degree in 82 from Loyola University in Chicago and private practice since 86 he's an active member of the American Dental Association as well as a member of the District of Columbia Dental Society were received the mm must award for continuing education teaching excellence he is a master in the academy general dentistry and a fellow in the International Congress for oral implantology the academy of Dentistry international and the International College of dentists he is also an accredited candidate of the American Academy of cosmetic dentistry which that I think that one is harder than the other ones I mean that is just the hardest one he is a past president of the patent Dental Society deduction Hudson's Patuxent Dental Society and Southern Maryland dental study club as well as founder member of several study clubs he's a graduate of the Pacific aesthetic continuum pack regarded as the pinnacle of postdoctoral cosmetic training in a light patient environment Dr. David Horne Burke is amazing dr. gray served a four-year term on the 88 council on scientific affairs in July he was awarded the Academy of General Dentistry prestigious lifelong learning and service recognition congratulations man that is amazing it's only been bestowed on a hundred and fifteen dentists ever he is an international lecturer at dental conferences on current technologies in dentistry he has spoken in more than 200 US cities and eight countries he is a continuing and member mentor advisor instructor at LD Panky in Key Biscayne the Dawson Institute in St. Petersburg a board member of the Texas Institute for Advanced Dental Studies he is also a member of the Arlington free clinic dr. gray distinguished affiliation with these leading dental organizations enables him to bring the most advanced techniques to dentistry I mean I could go on and on hell I mean hell I am restart on this line you have you have certified more than 20,000 dentists in Invisalign I mean I mean is there what are you gonna do for an encore you're just gonna you're gonna have to think of something you're gonna have to jump off the ad a building at 22 stories and free a free base of land on the what do they call that BASE jumping okay I think I think I think the only thing you left to do is base jump off the  ada building and I called yet because I um you were lasted and you're always in the news so the Washington deal there was an article says we took Brian Grady D a shopping at a CVS toothpaste aisle here's what he would buy and I thought it myself oh hell I wouldn't know what you would buy and I mean you're just you're just a hell but an American man so I think so much for coming on this show today it's really an honor to have you on the program now I just want to start with the questions the most obvious you're in Washington DC I assume you can't give the names of any politicians or congressmen or senators but do you ever you ever wonder why you're seeing patients or there's never been a dentist in the White House of the Supreme Court but there are five in Congress and one of them was actually I went to Creighton University and he I was on the ninth I was in 915 Swanson and he was on 8th floor Swanson and in Flagstaff and then there's one from Idaho there's one from Georgia he ever what have you have you ever thought about being a politician I mean if anybody could do it it'd be you 

Dr. Brian Gray: thank you so much Howard first off it's  not to spend some time with you I appreciate it I haven't seen you in ages I think the last time I actually saw you were huddled in a corner of Orlando Airport when we were both trying to find a flight out after a storm or something it was a long time ago but I'll forever remember it and it just kind of was burned in my mind I need to make a correction I'm a accreditation candidate I'm not accredited with the Academy of cosmetic dentistry it's as you know it's a challenging ongoing process but it's one of those things that I really want to take the boxes on and and complete you know it's a funny I was talking with my wife who's also a dentist and my best friend and the reason is that we have two separate practices so so we'd like to say we have two practices in one marriage but we're talking about just the challenges of the AACD accreditation and 

Howard: you know just some of the various things that can happen along the way so I just wanted to clear that up B I got my Eagle Scout and my black belt on eBay for $9.99 and I saw a fellowship in a CD on that so I picked up all three they had a three for one but I continued I think you really do a beauty Eagle Scout if I'm not if I'm not mistaken about the politicians

Dr. Brian Gray: you know it's it's a funny town to work in bi I originally from the Midwest I went to Georgetown and they actually closed four years after I after I left so I was I was able to get out of there but I think probably with some of the fires and other things that we caused that maybe I shut it down was a great school it's a great education and I ended up staying in DC and when we're blessed to see just to treat a lot of interesting and unique people in our practice and I actually was asked by a senator a few years ago hey you know you seem like the perfect guy to run for office and I thought for maybe about four seconds thinking about just scrolling through the things in the past and probably being responsible for closing down Georgetown they realized there wasn't a chance in hell I would survive the skeletons in my closet so no I love what I'm doing I'd rather I'd rather treat them than actually go down to Capitol Hill and work down there 

Howard: so it's uh it's Paul Gosar who likes a who's from Flagstaff I've known him for 30 years Mike Simpson Dru Ferguson Brian babe that is that is amazing uh but yeah my guy couldn't think of a worse job could you think of a worse job than that I just 

Dr. Brian Gray: it's just especially you know it's funny because nowadays it's you know you know that the political atmospheres like around the country and it's so polarized and you know we used to routinely have congressmen and politicians in the office at the same time it was no big deal and they chat in the reception area we honestly just have over the past year so we we kind of treat them like divorcees we try we look at the schedule and make sure we don't have opposing sides in at the same time it's kind of crazy but I'm hoping you know the things things change one way or another so that there's I think more some civility in the world but right now it's kind of a crazy place here in DC 

Howard:  I you know I call this show uh dental dentistry uncensored because I don't want to talk about anything that everybody agrees on and I also want to explain to the young kids that they don't know this that it's called channel conflict when you're asking a good fellow Irish dentist man to throw his friends and peers under a brush it's just not cool and then I had then I go do it but what you weren't you wrote that out article about the toothpaste and all that kind of stuff and now Colgate is buying they're starting to buy the new CBD toothpaste oils and they're starting to do their and my gosh I hadn't tweeted that out for one second Colgate to acquire hello products brand launching a line of cannabidiol canna video containing toothpaste mouthwash lip balms first first reply this is a terrible idea I don't know of any benefit to oral health from cannabidiol in fact it's more likely to give it but is it is it high risk to the brand when your Colgate crass Listerine these big mom-and-pop legendary companies you're like Mickey Mouse and now you turn on the new Mickey Mouse cartoon and she's getting high with many I mean does this uh does this work or is it off what are your thoughts on that is it high risk or just what is 

Dr. Brian Gray: it just interviewed for and it was kind of funny because it said they did the interview you know I they asked me if I'd go up and meet him at the CVS and walk through the aisle with them and I thought I'd be kind of fun you know be something different and I did it and then you're familiar enough with with articles and what you know what they do is that some months went by and then they call you up for a for a check you know that they're gonna go ahead and they're gonna do your there's a check on things to see the check the validity so they don't actually ever let you read an article but they ask you the fact check questions and then you're supposed to you know just say yes or no or expound on them so as soon as I actually read it in print I was I was kind of it was kind of funny because there were things in there that I didn't actually say or take a little bit out of context and to be honest with you it ties right in with the whole CBD oil thing you know kind of like bad news still sells so you know as a scientist there's as far as I'm concerned little to zero validity and having CBD oil in toothpaste circles at palm but you know what it's gonna sell and they'll get shelf space with it which is I think the biggest thing is that you know the companies are always looking for something that gives them shelf space the stores like CBS are always looking for new products that people are going to come in and buy it's what drives them in and what makes them take it off the shelf so I don't see it going away I think it's like a lot of things in dentistry and in the world today so you have at it folks I it's if you want to really probably the ultimate combination it'll be it'll be CBD toothpaste with tumeric in it and charcoal that's probably gonna be the next ultimate combination

Howard:  well you know the I can see how the young kids coming out of school can look at you and say oh my god talk about burn the ships when you get to the source oh that no one can retreat you got out of dental school and they close your dental school down and then you practice throughout the 80's 90's and all that and then they're coming out of school 2020 with $400,000 in debt and they're say yeah they're looking at dogs like I said yeah you guys graduated in the glory days when I went after I got out of school they closed down dental schools they go it was Georgetown Farley Dickinson st. Louis Loyola and  we did great and they're saying well now it's the other end so my question to you is I'm what would you say to a 25 year old who just graduated on old school and she says yeah dude you got out in the glory days the golden years and  now it's not that anymore it's it now and now it's all bad and you got out when it was all good well what would you say to her would you agree with her would you argue with her what would you say 

Dr. Brian Gray: I think I first counselor that it you know and we hear this all the time this is still one of the best professions you could ever be in it's  a wonderful thing we did I did I again you heard it I'm Irish Catholic came from the south side of Chicago there were seven kids in my family and  it basically was like oh you want to go to college that's really awesome how you gonna do it you know and you want to go to that school hey man we are 100% behind you how you gonna do it so I got a lot of debt you know what to to private schools but really felt that they were gonna be the best for my education I knew I want to be a dentist I was in high school it's kind of one of those weird dental things of course and and came out with a lot of debt and then I knuckle down and just say you know that was Eddie ate macaroni and cheese for a long time and paid it off and I don't want to sound like you know walk to school in the snow type of deal but you know the debt was just part of it and it was something that we managed and it has changed we've got a young associate that's got four over four I think sorry just about $400,000 in debt as you know that's the average right now I remember I was teaching at Temple six years ago and I did third year students I have the pleasure of teaching at about eight or nine universities every year for a one-day course and I always ask them the third-year students and how they come up around the podium afterwards and I was just say hey you know what's your debt and it was in 2013 so seven years ago was the first time I had a kid third year who said he had a half a million dollars in debt I routinely see that now routinely it's hard to find someone who doesn't have a half million dollars and I actually was made aware last year of a strategy that you mayor again sounded old but you may not be aware of you know there's  a thing that they can do with there's government debt forgiveness so they literally pay the interest you know they don't default they pay interest on their loans and then in 20 years the loans are forgiven and it's kind of sounds like a good deal but then I did a little bit of research and it actually with the truth of the matter is you pay the interest for 20 years and the loans are forgiven but then it's  taxed as ordinary income the death is forgiven so you know if you sit down and you do the math you're not really saving anything at the end of 20 years plus you've carried all this load so it kind of goes back to that I think the old old school mentality of what your dad and my dad you know used to say which is like hey man dad just just kill it you know you got a mortgage pound it down whatever it was and that's my suggestion is to just knuckle under and and take care of it I I see it as a crisis as you know I think that's gonna be a big thing in the future that we'll see student debt it's I think it's the second biggest thing behind mortgages right now in America if I'm not mistaken but yeah I do see it as an issue but I wouldn't trade it for the world I still think it's a wonderful profession the avenues are all different we see a lot of people going into corporate DSOs but the opportunity to do you know wonderful fee-for-service private practice still exists you just have to set yourself apart you've got to be unique one of a kind offer consistent excellent service and you'll have patients so so it's out there but it's you know a unique model so I my heart goes out to them to the students these days but I think it can be done

Howard:  um did you meet your wife in dental school was she a Georgetown classmate

Dr. Brian Gray: she was a Georgetown she was two years behind me and the short story is that a and as I've mentioned I am put myself through school I had three jobs in school I parked cars I did research in pharmacology and I I fixed the broken dental equipment it was a my job was to in essence be like a glorified custodian but it was a great work-study job so I could go to this library and study and then when I needed to break an egg grab my cart which was a cart with you know thrills of all that stuff but I'd walk around the first and second year labs and I have a list of slips of whatever was broken and and number 36 like always had this crap broken and I just had to find out if it was a disc or if I was fixing it bad and so I went by in the middle of the day once and you know depends since I was two years ahead of her she thought I thought it was the janitor she didn't know that I was so there so then she told her so you know then we ended up going out on a date and she told her mom that she was dating a custodian and her mom started crying and I was like you know we we sent you to Boston College and now you're at Georgetown and you're dating a janitor so so we're still married so it worked out okay but yeah that we met at school and it was because her stuff was always broken and it was because I probably didn't do a good job fixing it that is awesome

Howard:  um so when these kids come out of school and but that's who's doing podcast I mean when I say send do please send me an email Howard at dental town comm tell me where you're from what country leave notes in the comments a quarter amar still in dental school and all the rest are are under 30 that that's the podcast like like are you on tik-tok or snapchat 

Dr. Brian Gray: you know I try to stay current with those terms because millennial kids right and when I first started probably check it out but I never had a vine account 

Howard: I don't know if you have a vine account but or that other stuff so my three-year-old actually got mad at me and took my phone away cuz I was taking too long to pull up the video and she pulled it up in like one nanosecond but anyway um so there so we're talking to the younger kids and they come out of school they got some very succinct questions and they're looking to older guys like us to lead them dill first of all there's ten specialties I mean there's endo pareo pedo profs whatever and they have that $400,000 a debt they gotta pay off and you you hell you've written articles on the clues and aesthetics and biz line everything what would advice would you give her where do you think there's areas in dentistry that are gonna be have more demand and need more supply of than other areas would you rather be what would advice would you give someone $400,000 in debt 

Dr. Brian Gray: so that that you know I think the first thing is to not go under and just you know to you know no you're gonna have to work long hard hours yeah you know you work Saturday so I work Saturdays at I'm coming in when we first got started and and that's tough but it's okay I do think that there's going to be some unique areas in dentistry that are really gonna I think be wonderful opportunities and  I think that's the way we have to look at it you know that that all saying that the Chinese symbol for crisis is also the symbol for opportunity the truth of the matter it's its opportunity on a cautious wind but yeah that to me if we look at some of those things there's great opportunity out there what I think I haven't seen work really well as people who try to be the jack-of-all-trades you know try and put in an implant every three months try and do 2nd and 3rd molar endo you know twice a year and that type of thing and I understand you know if you're hungry you're gonna do whatever you can hopefully you're gonna do it ethically and do your best but it kind of comes back to that thing about all those different specialties you know if you're doing something that's in one of the specialties you should be doing it at the same level as the specialists themselves you know the standard of care of the specialist so it means you need to really dig deep into whatever you're doing I think that sleep medicine is a really really neat area I see a lot of stuff going on with a Ashe I think that the whole oral systemic thing is it's just a really really cool area and I would being honest I would know little to nothing about if my wife wasn't fully embedded in that in that area there's just so much growth in there so you got you got sleep he got the oral systemic stuff I see a massive pandemic on its way as far as the whole clear liner thing is going at you know the short story on that is that this line disrupted the market in 97 and 98 when it was first came up with the idea 99 they came out with that they ran with it for a number of years their patent started to expire in 2018 October and everyone was you know waiting on the edges for that to happen and it happened before it even did there were competitors out there like Gordo Claire and some of the other ones I'm sorry Claire correct but right now clear correct are they what's that clear correct that was bought by strauman right yeah yes we see it a lot of that the consolidation going on so that in essence it became the Wild West the doors open but before that even occurred you know the the smile direct which is one of the direct-to-consumer companies was already geared up and running with it and to me this is probably the biggest tragedy that I see in dentistry as you know I'm an occlusion guy as a matter of fact one of the other times that we first saw each other was when you took the first level Panky course I think I think we were the same one whatever so that was back in the 80s or whatever it's a long time ago but I'm an occlusion guy and I'm incredibly worried about what's going on out there with the direct-to-consumer and we're not putting the genie back in the bottle there's not a chance that this is going to be corrected via litigation it'll never get kids you know it's like prohibition you're not going to take away alcohol or etc it's out there and as a matter of fact I had a couple of our recent faculty meetings I was I was able to see some of the future and which we knew was coming but it's here now and within a year you'll see it is that we're gonna move past the direct-to-consumer companies there's no reason for us to even have to do that you're gonna be able to scan your own mouth with a wand that'll be about the size of a big pen it'll be flexible and it'll snap onto your cell phone from that you will then be able to send all your data to your own printer that's gonna be in your house and you're gonna use AI driven software that's gonna move teeth without the it's you're gonna buy a software package and be able to crank out aligners yourself at home you know on your workbench or at your kitchen table or whatever this is not like you know Star Trek this is it this is gonna happen and it's gonna happen sooner than people think the challenge is that you know for God's sakes dentists any orthodontist don't even know in essence where sometimes to put teeth and when we don't put teeth in the right position something's gonna give either the tooth that's gonna give you're gonna have to chip we're break down there you're gonna have the period option break we're down you're gonna have bone loss muscle soreness or the worst of all you're gonna have joint dysfunction and that's where this is all leading is that there's these people who get partway through treatment and quit or you've got we've had two companies as directed consumer companies have gone out of business with patients in the middle of treatment and they've got no recourse now or you've got ones that you start directed well and so you've got all these people that get halfway through treatment and they're walking around like dental cripples and don't even know it to me it's like filete imide I mean it's not it's gonna be something we're not gonna really notice for 15-20 years and then it's gonna you're gonna have people with significant defects in their jaw unable to chew and eat and speak and the worst part is they're probably not to have the money to be able to address it to treat him so I see a lot of that in the future and I think there will be a lot of opportunity for dentists to be able to step in and use their time skill and judgment to helpfully hopefully put people back together

Howard:  so you're a big guy and you know a lot of people say that you know dentistry three diseases I carry Oh Perry occlusal and when you're talking about all those Invisalign there's a lot of hardcore occlusion guys that aren't impressed with orthodontists and occlusion they say they blow up the service be the curva wilson some pole for my custard yada yada yeah but my question is this seems like it seems like it's easy to transfer knowledge about caries it seems to be straightforward about Perrio why is it so difficult for so many smart dentists to be sitting in a room discussing occlusion and why why does it resemble more a debate about politics or religion than it does I mean do you agree with me or am I or my in a different buddy 

Dr. Brian Gray: you are a hundred percent right on it is you know you said a bunch of dentists talking about occlusion sit in the same room it's like the Tower of Babel it's like not even the same languages we see it all the time and and I love when I'm when I'm teaching to use an example first off I think it's more the skill set of the people that are doing it where we end up with some trouble if you and and my best example is that you know I'm Dawson Panky trained but my wife my wife of 35 years is lvi and people would be like holy crap that's that's like a gasoline and match you know I mean that you couldn't and my response is you know what I mean if we can live together and love each other we can have a big group hug on this whole occlusion thing it's not really that tough I mean the basics artists are very simple its husk foster relationship the hills in the valleys have to fit together it's it's we know the thing the protective mechanisms it's when the bottom team slide forward they need to guide off the to the front teeth that's anterior guidance with posterior disclosure when you slide sideways you should have canine guidance so that it takes his teeth out as you get older they're gonna wear down now everyone's gonna have a different philosophy about this but those basic principles are the same for each and every group and if you just start there and take the rest of the crap and put it in a bucket and throw it off the boat that's fine because the most important stuff is the principles that we talked about and really comes down to when I'm explaining to patients three things there's only three parts that you need to worry about it's the teeth it's the muscles which act like the sling and it's the ball and socket joint get those guys in harmony you're all set one of them gets out of harmony it affects the others so we just keep it that simple and I think that we're gonna be okay the rest of the stuff about the like you said the debates about you know the purpose be etcetera yeah there's a lot of validity to that but I need someone to just at least have a basic idea of occlusion and then we can have a conversation so so yeah and that's in particular I think that's where we need to come together more the other part about this that's changed so much is that it just really used to be you know there used to be a lot of impressions on what people felt was right and not a lot of science and we're finally getting really really great data you know you're you were talking earlier about I forget how we how we got on we one of the things we were talking about you know going to your your I guess if I take it back it was like what's the best lecture or best thing you could ever do or attend and I was at the Academy restored dentistry this past there's a midwinter so it's a Saturday Sunday and it by far is the best you know to me it's just like The Rock Show of Dentistry we get the best latest knowledge there and the things that are coming out now marrying digital with the condyle and the fossa are just incredible you know and just so we're learning so much now there's it's easier for us to understand where the disk needs to be how the Johnnies to open and you can take it back to the simple Balan Saket muscles act like a sling and teeth and then from there we can I think build on it so so yeah I'd rather do the group hug thing I think that you know there's a lot of opportunity for us to do that and then we can kind of carry forward 

Howard: you and I have got burned in the past you know buying bleeding-edge I remember there was targus vector us and that came apart there was a what was the one art glass there was the rudest thing nightcore nightcore oh my god so I graduated 87 from UMKC and I went to the greatest cosmetic dentist lecture and I don't want to say his name and they said I'm you know you do die cord and cementum with dura lon and you know they're really beauty high-end so I probably did like a thousand of those guess how many I had to cut off and replace for free Oh probably close to a thousand every single last one of them so um I want you to so how do you get advice because right now like I'll give you a class example when I saw that deal where you extracted tooth you put in there a pulverize it makes it the bone grafting material I just mind I was drooling all over myself I was on my knees like licking the curtain of the table but I but I stood up and said hell no I'm gonna let some 25 year old idiot do this for a couple years and tell me if it works but I'm 57 I I I don't got time for this bleeding edge stuff cuz you never know what's gonna go how would you like to buy that machine then find out 100 implants place in a row all failed no no I'd have to so so my question is what advice do you give when something new comes out well what would what makes you think bleeding edge leading edge by weight or the greater full theory let's let Mike eat your head Mike he'll eat anything let's push the bowl of cereal in front of Mikey see if that dummy will eat it

Dr. Brian Gray: that's awesome question so I  years ago I got burned and it actually I think it had a significant impact on my profession my professional outlook and that why I bought it I had a guy come in I bought a composite kit and so this was late 80s and you know he sold me the six hundred and fifty dollar made me go broke them you know that was four crowns back then or what I bought the kit and used it in in about seven or eight months I realized that every single composite that I put in had gone end up on me and I was just beside myself I ended up you know taking them all out I was I was just a upset I called up the rap and bugged him to the point where he finally quit and then I went to the regional manager and then the national and then I ended up with the CEO and he ended up saying you know listen if you really think he can help why don't you help us you know with the clinical aspect of this because that's where we're failed you know that's where we fell apart and and it was there like I started doing the clinical research which is you know a big part of our practice we're looking at anywhere between six and a dozen things at a time sometimes it's short a single visit sometimes you know we're finishing up a 15-year study which I'm excited about but but the idea is that if we take those things that work well on the bench and merriam with the stuff that works clinically we can get the stuff that's really going to last and I think give us the test of time thing that's why exactly what you said sometimes being the bleeding edge or the hot pointy tip of the spear is not a good place to be especially with a lot of the different we get a chance to I'd say the other interesting part is that probably 80% it's close to 80% of the stuff that we look at does not end up making it initially you know to the dentist it ends up going back and that's you know I think one of the Testaments to the to the research groups that they were able to work with to see some of these things and send them back so we can marry the bench testing with the clinical aspects and say you know what yeah what you're saying about its having to sit there 7 seconds it's not really accurate it's got to be there 17 seconds you know type of deal so bringing that back around if it's new and it seems like it's too good to be true go for the science go back and look at the science associated with it see if it's all company-sponsored you know and then look at the level you know if it's a case report that doesn't really buy it wonderful I've written case reports before you know it's great a great way of getting information out but that's the lowest level of scientific evidence you know I want a randomized double-blinded you know clinical trial this is ideal yet and then from there I could say yeah this is valid data stuff we can use so stuff that might seem too good to be true I there's you know a lot of really great things out there that aren't proving but I think lasers were initially kind of one of those areas where we were saying lasers could do a lot more than they you know then they actually could do in people's hands and nothing against the laser companies at all I think there's some wonderful aspects to them Arab region was another one ear abrasion is like an awesome thing but you know they're initially back in the 90s they were saying how you could you can do preps without anesthetic you know how many times we heard that and it cuts perfect clean corners etc and of course it didn't you know so it ended up kind of going off to the wayside I still use their abrasion on every single prep after I've cut and cleaned I'll go in there and make sure I've used that you know it's wonderful for that type of thing but you're not going to use that to clean out a class to prep a molar and expect to have anything that's going to work and do without anesthetic so if it seems too good to be true it probably is so whatever breeze using our you are using a little Danville deal or whatever reason it is you know it's funny to say that so that the Danville prep start is the checker cab of hair abrasion units we've got I think probably ten of them in the office or nine or ten and they just don't die I mean you can see why Danville ended up getting bought out and kind of riding off into the sunset it's because they made something that was so darn good you know it didn't need any parts replace then they still last you know we we try to wit the water they had the water curtain island we tried we had units with that we would just went back to the plain old ones they're easy to use they don't break they're great for cleaning stuff out cutting you can you can you know do pit and fissure stuff with them and prevented rough resin restorations but mostly you know if you're replacing an old amalgam and you're doing the cosmetic stuff you got to get that stain out and that's one of the best ways of doing it plus you know the benefits of you're gonna get two-thirds better bonding you know at least sixty six percent is what we see to enamel it's great so so yeah you know and not that we want to get off on the air abrasion shank but it's more about like you know let's use these things for what they're really good for let's same with lasers right you know there's a lot of claims about things that that lasers can do that you know there's some skepticism about and then there's other stuff that it's there you know lasers are the way to go so I think we see that a lot I'll kind of dig up another one you know we hear a lot now about different pareo techniques in particular tunneling procedures say and you know I want to see the scientific validity behind how that looks five years later compared to other techniques so it kind of makes some people mad and you know I've I've made a career doing that just having to Tom what's on my mind and and if it's good show me the science to

Howard:  Irish Catholic dentists never made anyone mad I mean that's just uh fight that's a fight just as permission excuse me may I join this fight and let's go to another fight because I actually don't even I believe in everything you said it I don't even believe in sealants I mean you're taking acid ATS technology and your asset at scene pits and fissures filled with Cheetos Doritos and and whatever and then you're bonding to that whereas I take Matt Danville my creature and spray that out and when you use the nice my creature you were in Denton a hundred percent of the time so they were all preventive resin restorations and then when I look at the research I mean most research says that half the sealants fail within a year so sealants still even a thing I mean are you are you bonding or do they test these bonding agents to Doritos and Lay's potato chips 

Dr. Brian Gray: so it's a great question because really what we're doing is we're you know get-together term right now we're semantics we're using semantics so we place sealants all the time in our office but my sealant is a preventive resident restoration so we you know we have a technique you have to use ear abrasion to open up and clean that fissure you're gonna ask you're gonna bond and then you're gonna put I don't care whatever you know low viscous material in there that is going to flow and seal it up Wow that's it's a seal it's really a prevent addressed or at resin restoration and that's why sealants have such a bad you know reputation is that there was a company in about ten years ago that was going around saying that you could use this hydrophilic sealant material and you didn't need to even etch and you know once again I had to call I'm like not a chance there's not a chance that that is gonna you're not bonding to a smear layer and having something stick it's baloney don't you know don't buy it especially if the smear layer is full of Doritos and Cheetos like you're saying so it's got to be clean you have to have really good enamel for to be able to do it follow those rules you're gonna be all set if not it's gonna be the type of sealant that you're talking about which has above sixty percent failure rate and

Howard:  you know to the young kids what I would really remind you if you're if you're under 30 is that um the way your brain works is when you're walking down the jungle and all sudden a lion or a tiger or cheetah jumps out your brain doesn't work like well pointed teeth that maybe a carnivore cuz if it ate grass it'd be a herbivore and it's looking at me and yeah that you we would be dead so your brain analyzes it instantly and you instantly fight-or-flight run away but then when you get into dentistry and school in college what happens you read the question and you say obviously that's false but then you start thinking and you start thinking then you turn your pencil around and your race and you circle the other one and you're always right the first time so what old people do that young people don't do is we listen to the little birdie on the shoulder and when you're listening to some spit some spill and your little birdie says it's so if your birdie told you let someone else do it but all I can tell young girl is you always know the right answer or you would have been eaten by a coyote 40 years ago you always know the right answer and then guess who talks you out of the right answer you talk yourself now you have the right answer your worst enemy lives between your ears you know and I think the older people just get more right answers wrong because we're too old and tired of like now that's we're not even gonna go there but you're young and you're you gotta run around the circle um I want to ask you don't think I'm you you have your MAGD and some kids come out of school and think what what is wrong with that guy that he had to take six thousand hours of continuing education and didn't you learn all that in dental school and some and some of the young kids get upset that in Arizona they gotta take they gotta take you know 18 hours every three years and they're like this is baloney and then I say well dr. grace take in six thousand hours they're like what is wrong with that guy white why did you get your MAGD and why do you take more hours of seee than the government requires of you so I'm sure that that's a probably a personality flaw and probably a C junkie one of the things is that

Dr. Brian Gray: I just love I just yearned for knowledge and in dentistry in particular because it's changing and you know I'd like to think it in dentistry again this now we're sounding like the old people that our fathers were that we used to say but you know in dentistry like well we're in it man things were changing at a geometric rate and you know and from what used to be just in essence like a mathematical curve when Tia metric I mean it's exponential now it's crazy you know routinely I'm comfortable saying if you're not taking a materials course every year you're practicing in the 90s I mean just you know they're the the changes are just coming so fast that yeah you can still get by with what's out there but there's other stuff that's better that's proven that's got five years stuff you know trials that show it etc so so I like it for that for that aspect and and I think the other thing is that you know I'm really just engaged with this profession and and I think if people look at it that way and don't look at it like it's a job they're gonna love doing that they're gonna love getting in there you know digging deep maybe just picking the one thing whatever it is it's oral systemic it's again airway which is a huge thing it's it's becoming an Invisalign expert it's someone who's wonderful at placing beautiful direct composites it takes takes time and courses to do that and that's the one thing that you know we hear nowadays all the time is that when when you come out of school at the end of four years you come out kind of thinking that you know a lot and it's not too long for a lot of us to realize that we don't know very much and that you know you go through that thing you know where you get to the final you get to the step where you you realize that you know you know you know that you know you know the whole thing about you don't know you know and all that stuff but I think that's the biggest thing and I was actually asking one of the students there was a student tutor we helped get you know who was actually lived in our basement while she was in her gap year is now at Midwestern outside Chicago in Downers Grove and she met came downtown I met my wife and I had the mid winter for dinner and we were talking with her about you know where we're at and I think part of it that's changed and made it better for students is that a lot of the schools have gone to did in essence proficiency or competency they don't they don't look at you know rote knowledge you've got to get X score on a test you need to show that you know how to do something and to me the best way to do that is with CE it for us that used to mean a lot of traveling around right we go everywhere to take courses I you know I remember trap flying all the way to see Joe Mossad and Kansas or wherever it was years ago just because I needed to get some process requirements removal process requirements you know now that stuff's available online and and you know god bless him the kids who come out today are able to just crank up and look at something in a half-hour and get you know the latest on it and our associates that type of guy you know he's like I talked with him about something and the best example is the other last week on Thursday I said well you know have you thought about just looking at extraction just distraction osteogenesis for this case because there's such a big defect in the jaw and I was like I don't know where the research is on that you know how you know how it's changed in the past five years and and by the end of the day he had like four different videos on it and a whole slew of articles and I think that's Ford's going so she is morphing I think that the idea of us having to accumulate hours and having tracked is a little bit different than it used to be but there's a ton of stuff out there that it's really helping to push us along it's a matter of you getting out there using it taking advantage of it

Howard:  the dental market I mean there's so the herd is eight billion humans there's about two million dentist ten percent of Myr in the United States but they only have four percent of the population so just for easy math a United States is ten percent of population with five percent of people so a rich country has twice as many but it seems like most of it is all flat I mean the cleanings exams fillings root cows it grows pretty much with the economy one and a half two and a half three percent the only thing in double-digit is clear aligners and implantology and I don't know whose oh you were the align educator of the year 2014 you're the number one certification speaker for a line you certified twenty thousand doctors and this deal I mean thanks for coming on this show but I'm what do you but you also do implants right

Dr. Brian Gray: I actually sucked surgically placing implants in ninety three before a lot of people I gave my kit to my oral surgeon and part of his that I was on the road a lot and and you know same deal it's like you know if I'm not putting in you know he's putting in eight a day right and you know if I'm putting in eight a month or eight a year I'm not doing my patients a service so we restore a ton of implants and and you know blessedly I get a lot of referrals from my oral surgeons and periodontist as I work with because they do you know they they get to put the screws in I think if you're competent same deal when I was at the Midwestern Arizona a couple years ago we had a I was talking with the students and there was a fourth-year student who had placed 56 implants as a fourth-year student you know why because he loved doing it and and they let him do it there there is a fact to the you know environment a wonderful learning environment it's a place where you know they said yeah go for it you can do that met the kid and talked with him he also built his own motorcycle which kind of gives you an idea of this type of brain but I think that those things are again you get competent with it run with it same thing with clear aligners if not limit yourself to what's the safe zone just like root canals you know don't be doing second molars stick with the bike upper bicuspids or whatever if you want to place implants start with the easy simple ones build your competency go from there don't ever get to the point where you have to call someone up to dig you out of trouble

Howard:  yeah I believe in the rule of 52 if you don't do it once you're definitely not doing you're definitely not making profit on it so whatever you're doing it's a hobby and if you were gonna you know I've only had two surgeries I had a my tonsillectomy when I was uh two or three and I had a vasectomy and I wouldn't have wanted any of those procedures done by someone who did it you know once a month sorry sir we accidentally removed your vas deferens you know I mean it's um so you gotta do it once a week but let's go back to this clear liner thing um do you do you think I mean when I go to a school in 87 the biggest brands of Colgate Crest Listerine they were already made but I think the biggest brand since we've been out of school for three decades has got to be Invisalign I mean everybody knows about it it's on talk shows it's in every country I don't care where you go where they're from they've all heard of these Invisalign um what would you say to a young kid who said they wanted to learn in this line what would you tell him 

Dr. Brian Gray: it's by far still the you know the way that I was you know we again we do a lot of clinical eval and research and I'd heard about it it was funny back then it wasn't available to GPS it was only available to orthodontists and you know what we you know a handful of us who loved doing that type of clinical research you know we just basically and run did to end run them by I found a orthodontist who was doing Invisalign and I said hey you know I want to do it and he says alright send your stuff to me I'll send it in it'll come back and then I'll give it to you and I was like okay then you'll tell me what to do right he's like yeah so it was great and they soon enough found out who these GP’s were and when it became available to GP’s which was an interesting story in itself they knew who we were and asked if we would help teach the course so that was how I got into it and again it was just that I got a recognition award about a month ago for my 20th year teaching Invisalign which is always when you get a Lifetime Achievement Award you know you're either gonna get fired or you're gonna die so I hope but it's not that either of those right away but the idea was that that I saw this technology and I done ortho as part of my MAGD and couldn't stand fixed was the other kit that I was happy to finally give away just it just wasn't you know I understood the physics I got it I just wasn't something that I enjoyed and when clear aligners came along it changed the game but it was really Wild West when we first got started we weren't really sure how well the movements were gonna be either it's a lot again just like a lot of the other occlusion stuff there was more people's feelings and opinions than there was science and that changed in 2003 when the faculty started asking align this listen you guys are a digital company you know instead of us teaching and what happened would be on any given Friday I'd be teaching a course in Richmond and David Gates to be teaching one in Vegas and ferry Jones to be teaching one in Chicago and we'd all be teaching the exact same slide deck completely differently you know as far as how we were gonna do it and we realized that went to the company and just said hey you know you guys can help us out you've got a digital model of how things start in a digital model of how things finished in a numerical path between them why don't you guys tell us what's working and what's not and from that they developed the protocols is that what they call the best practices protocols there initially there was about 600 cases in there then 6,000 and now if there's over 6 million it's the largest anonymous healthcare survey probably right now ever conducted it probably get passed at some point especially with what Google's doing with the nightingale project but but we see a ton of this stuff going on and it improving and what happened with Invisalign was they took the stuff that was working well and kept it in the bucket and stuff that wasn't they threw out and it got better and better so that's the biggest advantage that Invisalign has over pretty much all the other competitors is that they've got this data from 6 million cases and 7 million soon enough looking at the movements down to a tenth of a millimeter in any of the three axes a hundredth of a degree of rotation and you know less than you know the Newton centimeters of force is microscopic to be able to determine what the tooth is gonna do and how it's going to move the other thing that they're doing is a lot of reciprocal Anchorage which is really kind of crazy and cool is using the plastic in wine and pushing in one direction to help movement elsewhere which is kind of changed a game so I think that right now it's still you know again the big boy on the block loved it what they're doing and the research they've put a ton of money into it but as they know there's you know they're not the only game in town and there's a lot of other companies out there that are moving forward so I look at it this way I think you know Invisalign is gonna give you the best basics and basis for understanding clear aligners leverage staff they've got like over I think probably fifteen hundred hours of free CE and they're in there you know once you're once you're you've got a username and password anyone can go in there and use it and from there you know like if you got trouble with a case you're not really losing sleep at night you'll find an example in there with a blog and you know video and cleanse jack and all the other stuff so I see that as a great basis but also you know I'm gonna come swing back around to the whole technology thing that we were talking about I mean you won't be able to make design your kitchen table in the next couple years so being able to manage that is gonna be interesting but as far as doing it I think go at it and the one thing that I also like to to share is go at it could be smart you know you had just said the earlier about you know the last thing you want to do is something that's gonna dig you a hole and not be profitable the the profitable cases for me are still the bread and butter I got some lower crowding I got ortho relapse I mean that's where that's where the fun is when they when my staff see me look at you know some crazy class to a class-3 case and you know say yeah let's let's do this they they start rolling their eyes because they know I'm only doing it so I can get photos a lecture you know that and then we're not gonna make money and it's gonna take two years and longer but we're gonna learn something hopefully so don't do those cases don't do with the period gels my buddy you see called the bizarro cases stay away from that and and we routinely would see that teaching I'd have people shoot me an email saying hey you know what do you think about this case I got started and I'd be like oh my god it's a four bicuspid extraction case you know and you already took the bicuspids out and it wasn't a bicuspid extraction case you know it's like you can't unwind that stuff and now you're married to that patient for a lot longer than you want to be so pick the easy fun stuff I mean that and there's tons of patience to do it and they are the Fairlight missionaries for your practice so we love them you know they they go out there and love showing and sharing and also make sure you pick up on their body language like when they when you hand them a mirror to tell them what you know what's wrong why do you want braces and they grab it hard and they they sort real fast and they're really high energy run out the back door 

Howard: I mean there's nothing I'd like with a boy young kitties moms make them get him and he doesn't even care it's an older man he just looks at it real lip handed like yeah thanks but man when they grab it and they're intense and they're on it but back to Invisalign they've done so many millions of scans and a lot of people they know they've they're adding AI they know their Python programming and there's people talking on this on the street that they're gonna start getting some measurements for occlusion I mean we've had measurements and radiography for interproximal decay we've had it for gum disease with pocketing but we really haven't had a diagnostic measurement so much on TMJ from a radiograph but do you do you think do you think Joe Joseph M Hogan the CEO of aligned technology which owns Invisalign anti Tarot do you think they're gonna take that their knowledge base from Invisalign and all those scans and come out with some TMJ occlusion measurements do you think that's to look different 

Dr. Brian Gray: you know I've got to watch my NDA but what I can tell you is that they've got this huge database and that's just one of the areas it's one of the things that excites me the most there's really kind of three different levels of digital occlusal analysis that we see right now there's the scan version which with tight arrow it's called the inclusive gram three shapes got a really great one too it's basically the same thing but in essence it's really just a color map of how teeth fit together then this is the second level that we see is there's occlusal analysis that Invisalign has with clenched check and there's a couple other companies that are coming along with that too that show you heavy occlusal context that they can resolve with AI in essence they can help and with the help of tax at this point but it will be fully AI where you can help to set up the occlusion the keys to me still is that we don't have the contact vector for stuff that we need and that's only available through pressure mapping and there's just two people in the game on that there's t scan out of Boston and then bow just came up with something just recently they've had out for about a year now I think that looks at the pressure mapping and that's  where the data is that is and you know I think some people have figured it out finally but that the goldmine is knowing the vector forces with this because that'll technology 

Howard: should buy tech skin because obviously cuz tux scan that that's MIT that is serious stuff and the line technology is Silicon Valley it's kind of like west coast East Coast but you're absolutely a brilliantly absolutely correct I mean those are two amazing data companies could either of them do the others component by themselves or would it be better to make a Oreo cookie out of that and slam those two slices of bread together I said yeah the peanut butter chocolate I think it's like whipped cream cherry so at first I'm gonna back up you know but to back up for a sec I need to make it this disclosure statement I

Dr. Brian Gray: I don't own stock security or interest in any dental company I never have no one in my family does so I can if I I love being able to say I can speak from the heart I do have one of my good friends who started with me at a line teaching 20 years ago his dad bought a hundred thousand dollars with the blind stock at a dollar twenty four so and he still owns it and the kids got his he's you know my age and he's got his you know he's got a nice healthy inherits it's coming this way so it's saying that I don't know I don't own anything with the line I don't know anything with peace can but what I can tell you is that you hit it on the head T scans data you know the pressure mapping stuff comes out of MIT was developed by a dentist an engineer in the 80s and I mean this is this has been off patent for I can't I don't even know how long but it is still to me one of the best hidden secrets in dentistry they basically just keep the dental part of the t scan thing around I think for kicks and giggles they make their money off of you know Department of Defense and like you know the doctor Scholl's things you see if the CVS and you know put pressure stuff and mapping and not on all the other things but you know I know that at some point a standing company is going to if that sure is probably already happening but a scanning company is going to say you know what we need to marry this stuff because being able to look at the three-dimensional scan and then take the vector force data and put it together yeah just it's obvious I mean it's a matter of fact I'd be surprised if someone isn't already doing it so 

Howard: you're big and Dawson Dawson your rifle now it's your you said your wife was neuromuscular lvi they seem to really be more into text scan but I never I learned a lot about Tex ham and I was at LDI with Bill but I never learned it when I went through all the Continuum's of pinky or Pete Dawson is that changing just XK is pressure mapping is the MIT technology getting to where Dawson and those guys the west coast you know panky

Dr. Brian Gray: I did a lot of my friends Dawson bass and I would train Dawson pot there for a little bit but but panky now it has incorporated it in part of their stuff and I just know that from talking with people at the midwinter meeting that they've got that got it in there as do a lot of the other places I just can't understand why everyone wouldn't use it part of the thing is that it's you know the learning curve is a little weird but once you start using it you know it's one of the easiest things to do and and I like to say and I send us at my Aard lecture yesterday that I think it is the most efficient and precise way of determining seeded verifying not determining verifying seeded condylar position interferences and occlusal vector forces being on natural teeth prosthetics or implants doesn't matter you cannot look at the dots and tell me what which one hit harder which one hit first which one's got a broader surface area you can't really tell much with that stuff so yeah I think that it's it's finally coming around which i think would be a great thing I'd love to see it happen I they know that I'm a big fan I know that ton of people on both coasts are now finally embracing it it's it's getting over just that learning curve we take a T scan on every single patient at an initial exam now it's part of you know I think comprehensive additional exams should include a T scan a digital scan whatever type you know that you want to do a nice digital scan you need to have reading graphs or three-dimensional CB CT photographs too as well and there are you know the Itachi's had a unit for years that will do a CBC T of take a thousand digital photographs and stack them on top of each other so you can literally peel the layers off this stuff's all you know here so why don't we have that as a baseline I get every time a patient and we're gonna jump subjects a little bit here every time a patient is in my office that I don't have a baseline digital scan on them might arrow three shape plan Mecca you know care stream whatever it is if I don't have a skin on them I've lost the opportunity to capture that data I can't see what changes now but if I have that not only is this great medical legal thing but if I have that I can look at Oh I you know what I thought it was tooth where it's not to swear the tooth has moved oh I thought it was tooth moving it's not it's recession you know how many times you you're really familiar with this we would look at patients they come in in hygiene and we'd they say are my gums receding if you say I don't know let me hold a pareo probe up to it yeah right you know I mean like it even go as far as like taking a picture of a pair of probe next to it then we'll check it again in six months give me a break you know it doesn't work but we have this cool ability to get these three-dimensional scans we should be doing it on every single patient as a baseline and then at least yearly we're implementing in our office is that if you're getting bite wings you don't get the scan but if you're not we're gonna get the scanning in hygiene so we like to you know look at getting that on a regular basis what could be a better tool for showing people you named it right you said pareo Kerry Oh what could be better than showing people occlusal disease and say yeah might I have my teeth worn and we're like no your teeth haven't worn your teeth are wearing your teeth are wearing down your teeth are chipping we like to end ing we like to say you know no this is an active thing it's going on right now so that's kind of one of our bigger things is capturing that data and T scan and digital is is the way to do it marrying those two just makes the most sense

Howard:  so now I'm at the end of the hour so now Kyle can make it a clean cut or I cannot ask you a couple of overtime questions where if you say pass Kyle will just clean it off I don't want to get you into trouble but I'm gonna ask you to just like you care if I keep you out just for a couple politically incorrect you know I always enjoyed conversations with you so go ahead shoot shoot man what way is it with like on other technology like big-screen TVs when they came out they were a meter by a meter they cost five thousand dollars and everything's supposed to be your five fingers every year get faster better easier lower cost higher quality smaller and now that $5,000 big-screen which you and I couldn't even lift together you know it takes three guys to get it out of a truck now it's $500 and hangs on a deal so orthodontics has been 6500 every year since the 80s and then smiles direct club says well we're gonna use AI and we're gonna use technology and we're gonna dis intermediate the middle man like Walmart does by direct sell direct we're gonna lower all the costs and we're gonna get this thing down at 2500 and the dentist all circle around and say that's what you're supposed to do for TVs and cars and houses but not our profession and they start shooting back so how do you draw a line between making it look going from 6500 to 2500 getting it out to more people versus someone saying well you're just doing that to protect your own income so so when you badmouth smiles direct Club are you just a union boss for the dental ma you know the dental people you know you're just so so how do you differentiate what's good for you know other industries not good for us good for the goose is not for the gander so let's let's back up for just a second I know

Dr. Brian Gray: I don't want to sound like I'm bashing anyone I like to just kind of look at the data and then probably you know let my Irish smile shoot off more than it should so here's the thing I don't I don't fault the idea of minor tooth movement I think back all the way to dental school when a patient had a diastema and the professor said put a rubber band around those two teeth and changed it every day and let's see what happens right you know it's kind of a home solution it's tea and it would be the equivalent then I use this example all the time we can thank caiman and some others for coming out with whitening and the only reason they did is because they were using dioxide and you know and it was nothing but peroxide with the in a glycerin gel right and then we own that market well sure enough you know crest came along Procter gamble and you know turned white strips into you know quarter billion dollar industry and I don't fault them and if anyone is you know that that interview that would be started the whole conversation with you know in their eyes I say listen man if someone says that that you know one type of whitening is superior to another I just say show me the science you know so whitening woods two white strips will work and it'll work just as well as in office it just is a function of the percentage the viscosity and the time right and then of course the price so we charge more for the in office you know convenient procedure you could accomplish the same thing pretty much with white strips it's gonna take a lot longer but it could occur let's use that same example let's flip it over to to the minor tooth movement thing I understand it that we can do minor tooth movement and I honestly feel that like the rubber band around the Diaspar thing that can work so minor stuff you probably could get away with AI doing it but we go back to that thing that we talked about the three components what people often do and the best example of this is look at someone who's in the middle of ortho especially in clear aligners they've got these interferences in their bite where they bite down and they're only hitting on one tooth while you're jumping things around ideally as you get to the end things should settle and you should be able to get full contact across the arch the reason it's different with fixed by the way is that people are functioning on those teeth generally as it's occurring so we see less of it with fixed because it's one of the advantages they're functioning on those teeth where you're functioning with the liners in your mouth 22 hours a day so the simple stuff coming back to that whole direct-to-consumer thing the simple stuff I think you know is gonna be okay it's gonna work and if someone says it doesn't let's say okay you know show me that it doesn't what bothers me is that cases that are more than simple and require more than just some simple movement we still need attachments you know attachments on teeth it will get to a point where we don't but attachments on teeth are nothing more than a handle on a teacup you need to have you know a moment arm to create the proper amount of force to be able to accomplish a goal right and that's all you're doing is creating a moment arm with that attachment same as you would with a bracket and fixed so coming back to the simple stuff if it's a super simple movement yeah direct-to-consumer is probably gonna work but if you've got someone who's got a diastema on the top and crowding on the bottom and when they bite down the teeth all touch that's like a lid in a jar and now what you're looking to do is try and make the lid smaller and a jar bigger at the same time and that's physics man that does not work you need to manage that case it's gonna mean you're gonna have transverse and sagittal movement in there as well to help accomplish it and you need someone who knows what's going on now here's the interesting thing and I'm not bashing our professions but a directed consumer case that's simple and planned out well could be better and more successful than a poorly planned out easy-easy case by a dentist who doesn't know what's going on so that comes back to the whole skill set thing get to some courses learn what's going on bring up your steer you know your game and know that that directed consumer is not even the end we won't even need those companies you're gonna buy the software you're gonna have a printer and you're gonna do it at your kitchen table you know you'll be able to do in your kitchen table final question propel orthodontics myth and marketing or real world stuff so I miss the very first part of that say it again propel orthodontic pal yeah you know so that's that's any of the accelerated techniques it works it's really simple that's a cytokine cascade I love the idea behind it what you're doing is creating a ball of inflammation that inflammation in essence makes the bone soft and what you're doing is instead of moving a tooth through concrete you're moving it through quicksand but you gotta understand the science behind it so if you don't do it in the right place and you don't do it frequently enough it's not gonna work it all comes from the two Wilko brothers out of Pennsylvania's you know Wilco wicked onyx is where it all started and I mean that was slashes or oral surgeon and a periodontist perio ortho and you know they're very good they still are very protective of their method but you know so that's why you don't hear it called Wilco you hear it called accelerated ortho and I'll you know fifty other names surgically assisted etc the idea is that that cytokine cascade is the real deal it totally works you have to honor it it's just you're creating inflammation that's all you're doing so doing it right do it properly it definitely makes a difference I'm a little more skeptical of some of the other ones that we we've had a chance to do a lot of long-term clinical stuff with I was the first person in the country to get a bio locks unit and and we looked at we've looked at all of them we've looked at the near near-infrared and we've you know looked at vibration techniques etc to me the one that still stands out is the one where you're going to create the inflammation and make the bone soft 

Howard: my god I can listen to you for forty days and forty nights and I want to tell you honestly brain at the end of a long day working your butt off to hang out with me for an hour as it was truly an honor thank you so much for coming on the show and it was just an honor to podcast interview a legend thank you for all that you've done for dentistry

Dr. Brian Gray: I feel the same Howard it just fit great I look forward to see this event at one of the meeting soon alright buddy have a great evening you too thank you very much thank you  

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