Dentistry Uncensored with Howard Farran

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

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howard

Speaker 1 (00:07):

It is just a huge, huge honor for me today to be podcast interviewing Dr. Rab Josie, BDS Ms. PhD, FICD. He works as a senior product manager at GC America, where he manages direct and indirect restorative portfolios. He's passionate about innovation and dental materials and technologies. He leverages his clinical knowledge and scientific expertise to lead marketing and education programs at GC America. He serves as a reviewer for several reputed dental journals, such as Operative Dentistry and Journal of Prosthetic Dentistry. He's committed to continuous learning and currently pursuing an MBA program because he needs more initials after his name. Outside of his professional commitments, he enjoys spending time with family outdoors group exercises at Orange Theory, love that place and reading Yelp reviews to find the best places to eat. Multidisciplinary background, proven ability of managing projects in a fast paced environment, experience and building collaborative relationships with universities, industries and KOLs. 

 

Speaker 1 (01:08):

GC America is the leading private manufacturer, professional consumable dental products, and the fastest growing dental company in the world. Founded in 1992, GC America is the wholly owned subsidiary of GC Corp, the world's fourth largest dental company, which has been based in Tokyo, Japan since it was founded in 1921. I went there with three of my boys when I was lecturing in Japan a couple times and did four or five podcasts on location. It's God I love Japan. In 2014, recipient of the Demming Prize for total quality management. GC America is the first US dental company and only the fourth company in the United States to earn the world's oldest and most widely recognized total quality world award. GC America has exciting growth and expansion plans. My gosh, your resume goes on. And you've worked at Glidewell. I love Jim Glidewell. Been there, we've met there before and you also worked at the A DA on their product. 

 

Speaker 2 (02:07):

Congratulations side, 

 

Speaker 1 (02:09):

Man. You have such a wide range of experience in dentistry. Congratulations on your career. 

 

Speaker 2 (02:17):

Thank you, Howard. And it's my pleasure to be here. 

 

Speaker 1 (02:20):

So basically indirect restorations, bigger for you. Is that a bigger market than direct? Which one's bigger, indirect or direct? 

 

Speaker 2 (02:35):

That's a good question. So gc, traditionally glass animal, restorative. We have a 75% market share in that category, but also GC is known for demands of soap and cements fall under indirect restorative workflow. So on both sides. And yeah, those are our, I would say our bread and butter. But at the same time, GC has many quality products in both direct as well as indirect restorative workflow like composite resin or genial line and on the, and we are also developing new cadcam materials. So also we are expanding our indirect portfolio as well. 

 

Speaker 1 (03:28):

And I've always thought it was the reason I love architecture and dental materials, the dentistry is that every human needs a bathroom and a window and a door, but you go around to all the different countries and they're always slightly different. Like a toilet in Vietnam is just slightly different than one in India. And it's the same thing in dentistry where glass Omr is much bigger in Japan, Australia, New Zealand, some parts of the world. United States uses a lot less glass omr than say Japan and Australia, New Zealand. Did you see that around the world and what do you attribute that to? 

 

Speaker 2 (04:09):

Yeah, I think it is related to what is taught in dental school, I would say. And what are the trends, geographic trends I would say, but that's becoming less and less with social media and dentists are learning from the techniques all around the world. So definitely there is different, in Australia there is a lot more use of glass ionomer and sandwich technique. But recently I saw a survey by clinicians report and they did a survey in 2015 with dentists and glass animal use was very less like 30% of dentists. And then they did it again in 2021 and now it's 70%. So in 

 

Speaker 1 (05:04):

How many years in? 

 

Speaker 2 (05:07):

In maybe six or seven years, 

 

Speaker 1 (05:10):

It grew from 30 to 70%. 

 

Speaker 2 (05:12):

Yeah. So there was significant difference that there are two surveys showed and it could be because of more awareness, but at the same time when people say glass animal, they are not specific. Whether you are there using a cement, they could be using it as a Fuji cement and they can still call it glass an animal. And Fuji is such a common name and there are so many products with Fuji brand with different versions that they may not be specific in what they're replying in the survey. So that could be one of the reasons. But yeah, there is more awareness and we are seeing more growth in this category. 

 

Speaker 1 (05:59):

And I also, you're right about social media. Social media is huge and I think it also a lot of dental companies, you can't call something McDonald's in America and then call it Burger King in Australia. They really need to try to get one name for around the world or one name with the logo or whatever. Because I've seen a lot of people, you could tell they're confused because they don't realize they're talking about the same thing. I've seen that on Dentaltown and it's like, okay, well that's the same product. It just has a different name in Australia or New Zealand. But anyway. Yeah. That's amazing. So what's got you most excited at GC America now? What are you working on now that really got you excited? 

 

Speaker 2 (06:46):

So currently we are working on GC signature workflows. So first of them we are working on is indirect restorative workflow. So it's just a comprehensive solution that will streamline, streamline indirect restorative procedures for dentists, reduce inventory, increase efficiency while ensuring high quality that GC is known for. So we are looking at it in a more holistic way, how these different quality products fit together to streamline the direct procedure. 

 

Speaker 1 (07:29):

And how's that going? 

 

Speaker 2 (07:31):

It's going great. Yeah, so we are receiving great response for this initiative. So starting from two preparation to delivering the final restoration, there are many steps involved and our aim is to make these steps more efficient, reduce the time and increase efficiency. 

 

Speaker 1 (08:03):

So go over like on preparation or a lot of the success based on the preparation. And what do you think my dentist listening to you today could learn about preparation techniques, especially dental students? 

 

Speaker 2 (08:21):

Absolutely. So preparation is a crucial step. So like we learn in dental school at adequate resistance and retention form is necessary for the long-term success of the restoration and this resistance and retention form. I will speak from a technology perspective that or materials perspective being a gc and first and foremost is we should follow the REATION guidelines for a particular material. So if it's zirconia, we should follow the prep guidelines for zirconia. If it's a lithium dilate, the minimum prep requirements should be followed. So that's first and foremost. And then there are different techniques that will help streamline this workflow or make it more, for example, there is a technique called deep margin elevation technique. And so that just helps. We want to avoid sub jja margins in crown, but there are many situations where it becomes inevitable and what can you do in these situations? 

 

Speaker 2 (09:44):

So raising the jinja floor, using composite resin, using the code tofl and matrix span and raising the floor to achieve proper isolation. And that will also make the cleanup easier later. And we have solutions. So there are, we are talking about indirect workflow here, but there are many direct respiratory products that make our life easy in indirect workflow. So composite resins like highly filled flowable composite resin like genial universal injectable. So beauty of it is you get the same strength of a universal composite packable composite with deployable because it's highly filled, it has some amazing properties like ropy, what isotropy if the check you are trying to get ketchup in your burger and it doesn't come out if you just try to get out by getting out of the bottle, then you shake the bottle and then it becomes fluid and you get it easily. So that's ropy. Ropy is changing the viscosity of the material when you apply shear force to it, and that's what general universal injectable does. 

 

Speaker 2 (11:25):

When you place it, it stays foot, but when you apply pressure with instrument, when you apply sheer force with instrument composite instrument, it adapts to tooth. So apart from that, it can stack, it can really be stack is a stackable composite and also it comes with long and developmentary tips. So you can get it to the difficult to access areas especially it becomes essential when you're doing a deep margin elevation or subgenual margin. You want to in let's say second distal of second molar and that's where that long bendable metal tip can help you to get the material where you want it to be. 

 

Speaker 2 (12:22):

So yeah, there are different direct restorative solutions. Other solution to get the material or get the tooth to proper form, first you have to do core buildup. If it's a root, cannot treat tooth or severely damaged tooth before placing a crown, you need core buildup. And that's where fiber reinforced composites come into play. So these are different denting replacement materials. They are reinforced by e gloss fibers, just like steel rebars using to reinforce concrete in construction. And they really act, this research has shown that they really improve fracture toughness of the material. The crack has to go around the fiber or it's called crack bridging mechanism in material science. So it stops the crack or crack has to go around it. So the material you do not see catastrophic failures as you will see with composite, other composite resin, conventional composite resin. So some of these technologies can be used to really make your foundation. That's the preparation on which you are going to place your crown stronger. 

 

Speaker 1 (14:06):

Every periodontist I've had on this show has told me that only 5% of the referring dentists probably do 90% of their crown lengthening procedures. And it's a billable procedure. It's better for the long run. You would think the high end market. I mean when you look at the fact that heck, your average truck is a hundred grand, that's all you see in Arizona. It seems like everybody has a Toyota Tundra or a Ford one 50 or two 50 or three 50. And I just think there's a lot bigger market for crown lengthening than all these subgenual preps. I don't know why that Do you think that is? 

 

Speaker 2 (14:44):

Yeah, that's interesting. Yeah. So crown lengthening procedure is more invasive, I would say comparatively deep margin elevation, it's less invasive procedure that most general dentists can do by themselves. So maybe there is a trend towards doing deep margin elevation rather than inviting periodontic and doing crown lending. But yeah, that's an interesting part. 

 

Speaker 1 (15:16):

Now when I'm lecturing in Japan, Australia, and New Zealand, I ask them, why do you do the sandwich technique? And they always say that they just can't figure out why Americans don't want an active ingredient in their composite and they see the fluoride in the glass ionomer as an active ingredient and then they see the inert composites that Americans do all day long and they just don't get it. How do you weigh in on that? I mean, do you think that's why they use glass oer in the far east 10 times more than in America? 

 

Speaker 2 (15:57):

So yeah, maybe the fluoride release is definitely important. But interesting thing is that in US fluoride release or there is less restrictions from FDA on claiming fluoride release for FDA approval. So for example, in Europe, even glass animals cannot claim that there is fluoride release and fluoride release will help in cavities. So they're not allowed to make that claim. But in the US you can in fact make that claim that restoration is really, or restorative is really in fluoride. So again, I don't know the exact reason why. Maybe there are some. I think the importance of key opinion leaders or peers sharing these techniques with each other is very important. If glass animals becomes mainstay in United States then and more people talk about it, about its benefit benefits of sandwich technique, I think we will see more use of glass ANR in US as well. In Australia, there are many. For example, Dr. Graham and Dr, I don't know how to pronounce his last name. NGO, that's the spelling. 

 

Speaker 1 (17:46):

No, yeah, yeah, Dr. No, 

 

Speaker 2 (17:49):

No. Yeah, 

 

Speaker 1 (17:51):

I had a lecture to my study club in Phoenix, Arizona like 30 years ago. He was just amazing, man. I remember about, I don't know how long ago it was 15, 20 years ago, the world had two earthquakes the same size pretty much at the same time. One was in LA and one was in Haiti and in LA no one died because of all those regulations and building codes that everybody complains about and complains about, especially the construction workers. And then in Haiti, like a quarter million people died and you just, Michael Miller used to tell me at Reality magazine evaluating products that he said he's just in shock that dentists don't read the instructions and they also don't use a timer clock. The instructions will say brush on for 15 seconds and Michael will stand behind him with a stopwatch and his think, okay, that was three seconds, how did you get? 

 

Speaker 1 (18:49):

And the dentist, they don't read the instructions. It is kind of more like art. They're cooking, they don't need a recipe they don't need to look at, but they really do. And some of these, and then they mix kits too. They'll use the Bonnie agent from this box and a resident from another box's like dude, dude, somebody with a bunch of letters behind their name. I mean, I've been to GC and Tokyo and in Chicagoland, and I mean you guys got, you're a PhD and a dentist. I mean they got a lot of scientists that spent a lot of time working on this stuff. And then a lot of dentists just have a cavalier attitude toward it, you know what I mean? But yeah, there's got to be a stopwatch in every deal. You got to look at the instructions and it also really helps the assistant. 

 

Speaker 1 (19:34):

Remember Ola Christian, when Thermo Fill came out from Tulsa Dental products that got bought by Densify, when they sent it to her, she called the owner and she said, you know what I would do? I would stop and build the best little instruction card in the world. She goes, this is too complicated to read and everything. She goes, they need to see a five by seven index card that's laminated so you can wipe it off. And she thinks that was a really big help. And reading the instructions and all that kind of stuff is big. So you want to talk about on direct, on your indirects, you got the lii, do you pronounce it lii, the lithium silicate, LISI, 

 

Speaker 2 (20:22):

LII Block. 

 

Speaker 1 (20:23):

YeahI Block. And you got the Ceros SMART two 70. Talk about those. 

 

Speaker 2 (20:29):

Yeah. So lii block is a fully crystallized lithium dilate block. So it's a glass ceramic material. Glass ceramics are materials, which as the name suggests, it has a glass space and crystals of ceramics embedded in it. And lithium dilate is well-known glass ceramic material used in dentistry for more than a decade. Now it's known for, it is a combination of strength and aesthetics. It provides that. But how GC has revolutionized this material is now you don't need to fire it, you don't need one for that. And how we accomplish that, how scientists in Japan accomplish that is the material now has smaller crystals, densely packed sub micron crystals. 

 

Speaker 2 (21:34):

That queue is increased strength, but at the same time it can be made in a fully crystallized state. So you say that over time the total processing time comes down to average 19 minutes as compared to 50 minutes in conventional lithium, dia silicates. So huge time savings for dentists. That extra chair time, they can relax or they can use it to get another patient in. And also for patients that's a huge benefit instead of one and a half hour appointment time, if you can get crowned in less than an hour, 45 minutes, that's again, they're coming from work taking. Maybe some of them are taking a day off or some of them are taking a half day from work for them also for patients also, it's a huge benefit that you can get your treatment done in smaller amount of time. So that's your LAC block. 

 

Speaker 1 (22:47):

So you like the Lacey block, especially if it's the tooth is ceramic antagonist, but you like the serosort better if they have bruxism? 

 

Speaker 2 (22:58):

Yeah, so again, cera smartt is composite block. We call it hybrid ceramic, but it is high pressure, high temperature polymerize composite resin. And so it has more flex, it is more flexible as compared to ceramic. Ceramic as a class of material are more brittle as compared to composite resins which are more flexible. Resin polymer gives it more flexibility. So for bruster, the thought is that again, that it'll absorb more force, it'll flex more and as a result it wouldn't break. It may deform a little bit, but it won't break. You won't see a catastrophic failure. So that's the reason we recommend it for as these cera smart hyper ceramic material. 

 

Speaker 1 (24:03):

So on an indirect crown, what percent of them are being done milled in the office versus sending it to a traditional crown and bridge laboratory? And is that market growing? Is self milling chairside milling? Is it growing? Is it plateaued? How do you see that market as compared to conventional Crown Bridge labs? 

 

Speaker 2 (24:29):

That's a great question. So I would say chairside cat camp market hasn't taken off as you would imagine. So the technology has been around for several decades now, but approximately 15% of dentists currently use chairside care cam. There are more percenter of dentists who are using intraoral scanners, but they send a scan to the laboratory and laboratory uses CADCAM to design and mill the grounds. So they outsource this to laboratories, but overall there is increase in these. It is going to only increase in the future because the distinction between the, I mean many dentists, I even doing 3D printed crowns or 3D printing, they have 3D printers in the office. So the trend is towards consolidating or doing everything, but the adoption has been gradual. 

 

Speaker 1 (25:45):

Yeah. Is it the same, I assume you were talking about the United States market, is it curbside milling, is it very different in the other countries around the world or is it you see it about the same in the G 20 or how do you see it? 

 

Speaker 2 (26:02):

Yeah, I am more familiar with the market here. I do speak with my European and Australian colleagues, but I think the biggest market is in the US from what I understand. 

 

Speaker 1 (26:22):

And same thing. So back to the 15% of dentist chair site milling, what percent of the dentists use the polishing wheels or characterize it with the leafy blocks, with the luster paste one or the Sarah Smart with the optic glaze color? What percent of the dentists are doing that and talk about that for 

 

Speaker 2 (26:50):

Yeah, absolutely. So for lease block, our tagline is mill Polish place. So this material is designed for efficiency because of the small crystal size I mentioned earlier, it polishes beautifully within five minutes, approximately five minutes. And so 90% of the times dentists just polish them. And so if it is for posterior only, they're not concerned about characterizing it as much. But yeah, there are other 10% of times when they may think about it may be in the aesthetic zone and they may need to characterize it. And also the whole point of list block is time savings. You don't need to put it in the O one. And if you want to place it initial IQ one base, then you need to put it in the O one. So that kind of count, I mean then you add that time, it's not as much as the traditional process, but still the total time is around 30 minutes if you add that characterization step instead of 19 minutes if you polish. 

 

Speaker 2 (28:26):

So it's not a huge difference. But yeah, if you don't need it in the, let's say a first smaller or second molar on lay, then probably polishing is enough. For Cera Mart, it is the same thing. It's the composite block or hybrid ceramic block we call it. So it polishes beautifully just like composite. So polishing is the trend also, but there is the option of optic la, so you can make it look really beautiful with this like your resin coat and optic LA is actually one of the leading products in that category because it is just amazing technology because it's a liquid resin, but it's very highly wear resistant. It is nano field, nano field resin. And so when in material science as you decrease the particle size, they tend to clump together tend, but GC has a technology, we call it dispersion technology. So these small nanoparticles, they do not clump together. They still are separated within liquid resin liquid. So optic layer, that's how it's nano field and provides a very high wear resistance. 

 

Speaker 1 (30:08):

So the gc, that sounds for general chemical, doesn't it? 

 

Speaker 2 (30:13):

General chemicals, yes. 

 

Speaker 1 (30:14):

General chemical, yeah, 

 

Speaker 2 (30:16):

We say a great company, 

 

Speaker 1 (30:18):

Great company. I love it when you talk about the time going faster. I was born and raised in Kansas and when I got dental school, I almost stayed in Kansas just because they have that back then in 87 they had the expanded function dental assistant, but I came to Arizona and it took 'em 25 years to get that pass. But my gosh, it was amazing in Kansas when anybody could have these FTAs, but some dentists, they'd have their one chair and they'd do everything themselves with someone suctioning. And then there were other dentists who, my gosh, they would numb three rooms, go back and then prep the three rooms and then go back to their private office for 45 minutes and drink coffee and play on dentaltown while the expanded function, dental assistants just did everything. And I always thought those FTAs liked their job more because they got to do more. 

 

Speaker 1 (31:10):

In fact, the only two dental assistants I had that I and Vince, I need to go to dental school and go to dental schools because when I was assisting them, they would always be bumping my head with their head and sometimes they would push my head back and you stop out of the place, I know you want to see, but I'm actually the dentist trying to do this dentistry. And they go, yeah, but I can't see. And I'm like, man, you're so into this, you have to go be a dentist. But I think that FTA dental assistants are, they just seem twice as into dentistry as a regular dental assistant because they get to do more and they gravitate towards dentists who let them do their expanded functions. I can't tell you how many dentists I know. They say, you know what, if I walk in the room and I got to do a quadrant of MOD composites, oh, I hate that. 

 

Speaker 1 (32:00):

It's so tedious and there's no shortcuts and it's just an hour of solid work. And I'm like, man, you could just numb crap and leave the room with an efta. I think they do. I really think their work is higher quality because as a dentist is looking at it as like, oh, I got to go mow the yard and do four MOD composites. The assistant, they don't have to do a hygiene check. They schedule the amount of time they need and it just looks like it's just a better quality situation. Less burnout, a dentist doing the most minimal skill procedure, a bunch of fillings when the assistant, it's their maximum procedure. It'd be like Dennis doing a molar root canal number two or pulling out four impacted wisdom teeth and they just love it. What do you think the biggest mistakes are in cementation? 

 

Speaker 2 (32:55):

So cementation, the biggest mistakes are using a proper cement for a proper prep. What I see is, so there are two types of prep retentive preps and non retentive retentive preps. Looting is enough. You do not need adhesive or bonding non retentive prep. You must use bonding agent to get, so for example, only or if there is is a tempered prep or just a short stump left. I have seen many dentists still use just looting. They do not use bonding for that. And that's where the failure offers. So that one of the major, I would say mistakes during cementation, that understanding the cement selection for proper prep 

 

Speaker 1 (34:12):

On a barrel. You go back to barrels a thousand years ago they had that ring of metal, it was all made by wood and they put that ring of metal around the barrel. And you know what that ring of metal is called? A feral? A feral 

 

Speaker 1 (34:31):

And dentistry. We used a feral, but we stole it from beer cakes from 500,000 years ago. And man, if you can just get that two millimeter feral band, just think of a big barrel. I mean if you didn't have that feral metal collar around there, the whole thing, you couldn't stack them 10 high. But that feral is everything. And we stole that from the wine barrel makers and Dennis just got to, I guess they need to drink more wine so they don't forget about that feral. So crazy. So what is your product launch now? What are you working on now? You're the product manager? 

 

Speaker 2 (35:20):

Yeah, absolutely. So we have several products in pipeline, but they are in next generation, next generation ad, next generation restorative materials. I cannot really speak the details because it would be too early. But yeah, we have several products in pipeline that make dentistry faster, efficient and easier for dentists 

 

Speaker 1 (35:56):

In America. The dental meeting market is so fragmented because every state wants to have their own meetings. And in Europe it was the same thing. But that FDI meeting in Cologne, Germany where they just have it every other year, every two years, my gosh, it's the largest meeting in dentistry. But what I thought was so interesting about that is they do it every two years because for the next product launch, all the manufacturers said, we can't make something new every year. It's going to take two years. But what do you, being the product manager at gc, what do you think of that product cycle? Is it really about two years is what you need to go from an idea to a product launch or is it more like three or four or five? 

 

Speaker 2 (36:41):

It takes minimum 18 months, but more than that most times, yeah, it takes three to four years. Especially as a bigger companies, they have many processes in place. Also, in case of let's say GC is a global company, we have different markets, Japan, Europe, Australia, north America, and getting inputs from all those markets and agreeing on product specifications that meet the requirements of all markets is a challenge sometimes. Sometimes we have products developed specific to markets, but most of the times we get more efficiencies and if we develop the market that we can or develop the product that we can market all over the world. So typically I would say it takes two and a half or three years from idea to product launch, but it really varies depending on how complex the product is. 

 

Speaker 1 (37:57):

When you talk about your core buildup with fiber reinforced composite, kind of like putting reinforcement metal when you're laying big concrete rebarb is what we call it, do you see fiber post market growing or do you see the dentist still using the old fashioned metal post or where do you see that market? 

 

Speaker 2 (38:19):

Yeah, so post, the use of post has declined over the years, but there is, and with actually use with availability of these fiber reinforc composites, dentists see less need for putting a post. So post market has declined, but there is obviously a need of these four buildup materials and that market I think will keep on growing. There's also after COVID, I saw the news on New York Times that there was epidemic of cracked teeth. So again, something like cracked teeth, if you reinforce it with fiber reinforced material, it can increase the longevity of the material L longevity of the tooth. So overall, this market is growing another, since you mentioned fiber in post, another advantage of that is shrinkage. So these fibers also reduce the shrinkage stress pastel. Magna has done several studies on fiber reinforced materials and how they reduce the shrinkage and cus per deflection while when they're used for core beta. 

 

Speaker 1 (39:44):

It's kind of funny because a lot of dentists will say they don't use a fiber post cemented because they think the metal posts are stronger. But I've had 50 endodontists on this program in the last seven years that said the main purpose of a metal post is to fracture the tooth. And so there's a big schism there. The endodontists are saying, no, do not do this metal post, and if you've got to do a post, do something more flexible like fiber. And then the dentists don't think the fiber is strong enough, but it's just fracturing the tooth. So I think that was very interesting how you said that the rebar prevented crack propagation, how the crack's got to go around it. That is some. Do you figure that out with scanning electron microscope or how much do you got to magnify that to be able to figure that out following a crack? 

 

Speaker 2 (40:43):

Yeah, so these fibers are six micron in diameter and one 40 micron in length. So these are pretty small fibers. And yeah, it's a well-known mechanism. I mean I wish we had a clinical proof of that and there may be, which I don't know. But yeah, this is well known mechanism in material science that if you put a fiber in the material, it reinforces it. And we do a individual test called fracture toughness test. So fracture toughness is the property of the material that measures the resistance to crack provocation and fracturedness of our fiber reinforced composite is almost two to three times more than conventional composite resin. So that's how we know this is helping crack because factor toughness is two to three times higher than conventional composite 

 

Speaker 1 (41:54):

And a lot of sensitivity from a temporary is just because of saliva leaking in there and getting all contaminated. You guys also have that immediate dentin ceiling with G two bond or G premio. What do you think of that? Do you think that's mainly to prevent against contamination bond strength or do you think it's mostly postoperative sensitivity? 

 

Speaker 2 (42:23):

I think all three. It helps with all three. The research has shown that it helps with all three because when you apply this immediately seal the contaminated dentin. So it helps with the increase in bond strength and also with the operative post-op sensitivity 

 

Speaker 1 (42:46):

And 

 

Speaker 2 (42:46):

Especially G, sorry, one more point I remember was especially G premium born, it has a very thin film thickness that helps with, so one of the concerns dentists often have is the thickness of the burning agent and whether it'll affect the feet of the restoration layer feet of the crown. And here we have very thin layer of G premier bond and that really helps in this technique. Sorry, you were saying something. 

 

Speaker 1 (43:24):

No, I think that's good. I think that if you're a really, really good dentist, you get to do dentistry, but so many times you have to be an armchair psychologist and you see the question all the time on dentaltown, like you cement a crown a week later, they're coming back, they've come back three times and man, I'll tell you the most important and most expensive medicine in the world is a tincture of time. And my gosh, people just, they don't understand the healing phase of it and you really got to set their expectations. I mean, satisfaction equals perception minus expectation. I always would tell them, okay, now we just did a big filling and we just did a crown or whatever, and this is going to be sense on me. I just beat the hell out of your tooth and this tooth's going to talk to you and it may talk to you for a long time, so don't get, come back in and see me If you want talk about it, we can adjust the bite or check the bite or check things. 

 

Speaker 1 (44:26):

But even if the bite's perfect, I mean we drilled on the tooth at half a million RPMs. I mean it's not going to be pretty. And my friends that are in cosmetic surgery, oh my gosh, they said that they wish they just would've been a cosmetic psychologist because after they go in there at 50 and they think they're going to walk out of there at 25 and now they have all this sore and pain and it's not like they wanted and man setting expectations for a surgery and dentists are all surgeons, only 10% of MDs actually do surgery on people. 90% don't. Whereas dentistry, we're all surgeons. In fact, I don't even know why they should call the MDs physicians and they should call the dentist surgeons. I mean it started out as a barber dental surgeon and it's all surgery. So you have to deal with so much post-op and sensitivity getting your techniques. I always, when I think about Bonnie agents or techniques or whatever, I always prioritize what's going to have the last post-op sensitivity. I don't want this talking to the patient for six weeks because then I'm going to have to talk to 'em. And when you tell people you just got to give us some time, they don't want to hear that. Exactly. 

 

Speaker 1 (45:49):

Yeah. The young kids, you talked about earlier that most of the kids, I believe it use the products they use in dental school. I mean, I paid all that money for that dental education at UMKC and they had all these products and materials and I used to think that was the best marketing decision they ever made because I was brand loyal for decades. Decades. I mean, I had had something really wrong. And they say on dental town, we've proven with a thousand polls that word of mouth referral from their dental colleagues is what's driving any dental market. If all the research says, take the blue pill and your best friend says, no, it's the red pill, they're going to take the red pill. They trust this dentist because they're doing it. But yeah. So are you putting a lot of this in dental schools and what are your challenges with dental students and how's that market going? 

 

Speaker 2 (46:50):

So yeah. Yes, as you said, dentist school. Yeah, that's where dentists learn these techniques and materials, and that's a great way of introducing them to these materials and techniques. But one more thing, another place where we are concentrating on is dental support organizations. So many dentists. So the trend is they do not start their own practice right away. So after graduation, at least for a few years, they work for DSOs or some of them work for ds. The penetration of DSOs is increasing over the period of time. So we are also focusing on these standard support organizations. That's where many young dentists work after they graduate and getting into these practices and our main, just like list block efficiency and DSOs love that because they can increase their practice efficiency production. And so along with dental schools, that is another area where we are focusing and getting these young dentists acquainted with our materials. 

 

Speaker 1 (48:20):

And there's so much benefits from standardization. I mean, you go into any McDonald's, it's two lb patties, specials sauces, cheese, lettuce, onion on necessity, but it's a standardized product. But dentist, they got eight years, they say the best employees did not finish high school. You want 18 and under at Walmart or in the military or the Navy, they just follow orders. And as you get older and more educated, you are not good at following orders. And these DSOs, you would not believe their biggest clinical problem. Even if I told you what it was, you'd laugh. They can't get them to all the dentists in one office to agree on just five burrs for a crown prep. It's like, really? You need 17 burrs to do an MOD composite. Are you kidding me? And you listen to 'em and that's why they went to school and they're working with their hands and they tell you, oh, they need everything. 

 

Speaker 1 (49:15):

It's like, yeah, but I mean, think about the poor dental assistant. She's working with four dentists in this group practice and one needs 17 burrs to do a filling and one only needs three. And I don't know, I think the only solution is I tell 'em all. I say, well, you know what, since it's so stressful in your office, just tell the dentist to suck it up buttercup. And they're in charge of getting their own burrs. Just give 'em a bur block and just set it up and he or she can go in there and grab their own burrs because it just drives the assistants insane and all the burrs they need. But it's cute and funny and artistic. But man, it is a challenge on these DSOs. And by the way, shout out to the DSOs. I got dental school. The only place you could get a job is with the government. 

 

Speaker 1 (50:00):

I mean Army, Navy, air Force, Marines, public health, Indian Public Health Service. There wasn't that many options. So unless you came from the ovarian lottery club where your mom was a dentist, you're stuck with the military. And now these kids come out and they complain about DSOs law, but man, they sure they'll hire the entire graduating class, especially in the urban cities. They're not much into rural, but I also think they're good. I think competition helps any industry. And man, I saw that in Phoenix, Arizona when ClearChoice came in and started just all these 20 minute advertisements on all on fours, and they were charging 25,000 art. So here they are on tv, a $50,000 all on four, 20 minutes long. Every dentist, oral surgeon periodontist told me, oh my God, since they've been running all those ads that market share just growing, growing, growing, they see it on tv. 

 

Speaker 1 (51:01):

Then they think, I wonder my dentist does that. And then the consumer hours, I mean, like I said, when I got here in 87 on a Sunday, if you fell off your bike and broke your arm, the hospital's open 24 hours a day. But the dentist, good luck finding a dentist on Sunday. And the DSOs man, they rolled up here and the consumer got seven to seven, seven days a week. And that's another interesting thing I find very interesting about Asia, the different delivery system where you go to Singapore or Cambodia or Vietnam, they all have a dental hospital. They all have a 15 story building in downtown. This is dental hospital and the first four floors are general. Then they got a floor for each one of the specialties. And when people have a dental accident, they just go to the hospital. If it's tooth related, they go to the dental hospital, anything broken on the face and jaws and all that, they just go to the dental hospital and no one's done that in the United States. 

 

Speaker 1 (52:00):

I always wondered why nobody saw that business model. And then when I go to these hospitals around here in Phoenix, they say at least 10, 15, 20% of all their emergencies are dental and origin. And they tell 'em, we don't do dentistry here. And I always thought, that's so weird. I mean, if 15 or 20% of all the customers at Costco wanted a product, I'm pretty damn sure Costco would sell 'em that product. And I always wondered what is the deal with a hospital? You can deliver a baby, have a heart attack, amputate a foot, but you can't fix a tooth. Why is that so why is that? I mean, talk about mental roadblocks, but yeah, I know if you come back to Phoenix in a hundred years, I mean this city, just the city limits of Phoenix, not the valley, the valley's like 4 million, but just the city limits of Phoenix crow a hundred thousand people every year for 10 years in a row or more. And so I know if you come back in a hundred years, there's going to be a dental hospital in downtown Phoenix that's going to be 15, 20 stories tall because I've seen it. Then the other countries, they love that stuff. Well, my gosh, I can't believe how fast the time went. Is there anything you wanted to talk about that I didn't bring up? 

 

Speaker 2 (53:26):

Yeah, we pretty much covered everything, but I would like to bring everyone watching this podcast bring their attention to GC America website and we have what we talked today about indirect restorative workflow. We have a nice webpage that has all the resources, all the technique videos related to different procedures and materials and how they work together to provide efficient procedure. So please feel free to check out that workflow. That would be my, 

 

Speaker 1 (54:13):

And if you go to dentaltown and you type in on the search GC America, or you can put in the LISI lease C block for lithium silicate block. There's some great threads. I know you've posted a lot of times on Dentaltown and I thank you for always answering GC America questions at Dentaltown. It's 

 

Speaker 2 (54:35):

My pleasure. 

 

Speaker 1 (54:36):

Yeah. So thank you very much for all that you do for dentistry. And my final question for you is you have probably the most perfect teeth that's ever been on this show. Do you think that's why you fell in love with dentistry and became a dentist because you fell in love with your own smile? Was that a big part of it or what drove you to dentistry? 

 

Speaker 2 (54:55):

So yeah, that's the great question. So yeah, my career has been a journey that I never expected. So first of all, yes, I came to dentistry because I wanted something that will really make use of my something which is combination of art and science. And then I was more interested when I went to dentist school, I got more fascinated by science and technology side of dentistry. And that's why when I came to us to do my research in biomaterials, and that led to my interest working for a dental company and my interest on the business side of dentistry. So I just, one opportunity led to other, and I was open to embrace those opportunities. But to answer your question, yeah, I visited my family dentist and I was fascinated. I went there for observership before I went to dental school and I was fascinated by dental procedures, and that's how I decided to get into dentistry. And my smile came later. I had a big dias midline diastema until the age of 20, 25 or 27, and then I got it fixed several years ago with invisible aligners. 

 

Speaker 1 (56:43):

Yeah, that's another big trend. Invisalign is right here in Tempe, Arizona, and they got a big building and I mean, just what a huge company. I thought that was most interesting going back 20 years ago, I could be eating at any restaurant with my boys around the world, and if the waiter or waitress found out that we were here at a dental convention, first thing out of their mouth was Invisalign. I mean, that was the biggest brand growing in my, I mean, when I graduated you, you already had Pepsi and Coke, rast and Colgate and Listerine, and you already had pretty much all the big brand names. So I'd say that Invisalign brand was the biggest brand ever built in my professional lifetime. I mean, it was just, oh my. And that's why they didn't make a lot of money. I mean, for a lot of years they had had a PE ratio of 99 times earnings. The stock was so multiple, but it was because they were spending so much money in growth. When Jeff Bezos did that with Amazon, everybody clapped and then when did the same thing in Invisalign, everybody's like, Hey, where's your profitability? But hey, thanks for all you do and I'm sure I'll see you around. You're everywhere, so I'm sure I'll run. 

 

Speaker 2 (57:56):

Thank you so much for having me. It was really a pleasure talking with you. 

 

Speaker 1 (58:00):

Ah, thank you so much. Have a great day. 

 

Speaker 2 (58:03):

Thank you. Thank you, Howard.