Dentistry Uncensored with Howard Farran
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166 The State Of Edentulism with Michael Scherer : Dentistry Uncensored with Howard Farran

166 The State Of Edentulism with Michael Scherer : Dentistry Uncensored with Howard Farran

9/28/2015 2:00:00 AM   |   Comments: 0   |   Views: 523





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AUDIO - HSP #166 - Michael Scherer



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VIDEO - HSP #166 - Michael Scherer



Listen as Michael D. Scherer, DMD explains the rise of edentulism, some research and scientific backing supporting full arch implant dentistry, and treatment options for the future.

 

Dr. Michael Scherer is an Assistant Clinical Professor at Loma Linda University, a Clinical Instructor at University of Nevada – Las Vegas, and maintains a practice limited to prosthodontics and implant dentistry in Sonora, California. He is a fellow of the American College of Prosthodontists, has published articles related to implant dentistry, clinical prosthodontics, and digital technology with a special emphasis on implant overdentures. As an avid technology & computer hobbyist, Dr. Scherer’s involvement in digital implant dentistry has led him to develop and utilize new technology with CAD/CAM surgical systems, implement interactive CBCT implant planning, and outside of the box radiographic imaging concepts. Dr. Scherer also maintains “LearnLOCATOR”, “LearnLODI”, and “LearnSATURNO”- popular YouTube channels on standard and narrow diameter dental implant procedures.

 

 

Office:

Michael D Scherer, DMD, MS

14570 Mono Way, Suite I

Sonora, CA 95370

 

Phone: (209) 536-1954

 



Howard: It is a huge honor to be interviewing Dr. Michael Scherer today. I think it's ironic that your last name is Scherer as you're sharing information. I don't pay any of my guests for money, I don't get paid any money for many of my guests, I'm not here to promote a product or anything, I love doing podcast. It's my absolute, newest, hottest hobby. I'm coming up about a year and 150 of these things, I just like going to lunch with a guy like you. By the way, Michael Scherer, you're a sharer of information but you said Scherer actually originates from a barber surgeon so you were named correctly at birth?

Michael: Yeah, this is true. Certainly, my father was a medical surgeon, my grandfather was a medical surgeon before that. I'm the black sheep, I went into dentistry. The funny thing is is that they're all laughing now but dentists ... I mean, we have a wonderful career. The [inaudible 00:01:04] potential of dentistry, not only with implant dentistry but with all of dentistry in general, it's amazing. This is the best profession, I wouldn't change it for the world.

Howard: What's ironic about what you just said is the curse of dentistry because in dentistry, we're all surgeons. We all work with our hands in surgery, whereas the physicians, if they don't really have the eye-hand coordination [whether it's 00:01:27] heart surgery, brain surgery, whatever, they can go be a family physician who pretty much just read scripts, talks to people, writes prescriptions and blood work. We're all surgeons.

Michael: That is the absolute truth. That's also somewhat intimidating too because certainly if one of us goes down and we're out in bike riding accident or we decide to go snowmobiling and you take a header or you take a fall, as a dentist, you don't necessarily have the ability to say, "No big deal, I can be in a cast for a couple of weeks." No, it's a big deal. One of my staff members right now is out because she fell off a horse. It's been 2 and a half months and we're holding a spot for her because she's such a dynamo. As a dentist, I have to make second choices about doing crazy stuff because I got to feed all of them, keep them working and employed. It's a heavy weight but I take it very seriously.

Howard: You're a prosthodontist and you're a very serious prosthodontist. You're an assistant clinical professor at Loma Linda. You're a clinical instructor at University of Nevada. You have a practice limited to prosthodontics and implant dentistry in Sonora, California. To our listeners, where is Sonora, California? Most of us in geography only learn that California has San Diego, LA and San Fran. We haven't heard of the other 99,000 cities in California.

Michael: That's true. It's funny too because it's a sore subject here in Sonora because everybody thinks it's called Sonoma. You think that's where you're growing grapes, wine and everything. We're the gold country here in the Sierra Nevada foothills. It's a small town, about 2 hours east of San Francisco.

Originally, I came from Florida. People asked me, "How the heck did you end up in Sonora?" It was just kind of a strange series of events. My wife, she's also a dentist, she's an orthodontist. She used to come up here to Yosemite and the gold country as a kid. When the practice became available, it was just the right time, the right place. It's a more rural type environment and culture. There's only 5,000 people in my small town but, our county, we draw approximately 65 to 75,000 people. People then take it a step further and say, "You're a prosthodontist, what are you doing in this community?" Well, in all fairness, there's quite a few retirees in my area and it's just been beautiful. We really had just tremendous luck with being able to connect with the community and to be able to offer the type of services that they're really asking for. It's really a lot of fun.

Howard: Is it founded by forty-niners, in 1849?

Michael: It was. Actually, the gold was not ... It's found not too far away from here, a few miles north of here. Actually, the largest gold nugget ever to come out of California is about 5 minutes away from my office. Whenever I go for a walk in the backyard, you betcha, I'm looking around that's for sure. Sonora was actually named after the initial gold rush people of the part of Mexico, the Sonoran Desert. Those are the people that first settled in this area and they named the town after that.

Howard: This is something that we don't talk about, 64 years of age, 10% of America are edentulous, they have no teeth. 74 years of age in America is significantly higher. What is the state of edentulism? Is it growing? Is it shrinking? Is edentulism here to stay for another hundred years?

Michael: That's a fantastic question. Because a lot of us in dentistry and our focus in the clinical as well as the academic side which can be somewhat frustrating for a lot of clinicians that really do removable dentistry quite a bit is the sentiment that edentulism is going away. Yes, the rate is declining. There is a constant shift over the past 30 years or so of declining rate of edentulism. In this country, we have this really magic statistic, it's the baby boom population shift. Over the next 15 years approximately, we're actually going to have a net increase of the number of edentulous arches as we move forward. The rate is decreasing; however, the total number of edentulous patients and edentulous arches is actually increasing.

The focus on full-arch implant dentistry is significant. Certainly that depends upon your area, maybe if you're practicing in a place that's in a much younger population, you might not see it as much. I'll tell you, I mentioned before we're not far from San Francisco, in the Bay Area, and the Bay Area is one of the highest socio-economic areas in terms of income and living costs in the whole country. When I meet clinicians even from those areas, they say, "No, I'm really seeing an uptake in the number of edentulous arches that I'm treating." It really is very diverse.

What happens is that, yes, we tend to focus in on the near cases and the cosmetic dentistry but, yes, as you mentioned before, we're all medical surgeons, we're all cosmetic dentists. No matter what type of dentistry you do or surgery, we all treat aesthetics. When it comes down to it, the full-arch implant dentistry and removable is a true aesthetic rehabilitation. Every time we work on our patients for complete dentures or with full-arch implant dentistry, we are doing full-arch reconstruction. Across the board, it's just frustrating because people have the philosophy that I should just ignore it. I'm going to go take courses that focus on bonding number 8, 9 or putting an implant at number 8, 9 and to tell you the truth, if I focus 90% of my practice which is what some of the experts in implant dentistry and aesthetic leaders claim that they do, not only would I not have any patients to treat, I would be poor and I would probably be so stressed because those cases are just so incredibly demanding, give me a denture any day.

Howard: Exactly. Very well said. My first question to you is something I've seen since I got out of school in '87 to now, in these 28 years, is that on Dentaltown where we have 202,000 registered dentists from 206 countries, we had to separate the CAD/CAM, Cerec from E4D. Because anytime some poor E4D guy would make a post, somebody from Cerec would have to go on there and say, "You got the wrong system." It's like, "You know, buddy. He's passed that, he got a E4D." Can we just talk about the E4D without always have to have a Cerec nut job in there saying, "You made the wrong decision."

We also had to separate the dental implants from many dental implants because anytime someone posted many dental implant case, all this people would go in there and say that many of these aren't justified, they should have been [full form 00:08:32] implants, et cetera, et cetera. Yet, there are some oral surgeons who say that if someone walks in your office with a denture and all you can treatment plan is a Mercedes-Benz, 6 implants on lower, 6 on the upper, 2, 12 unit bridges for 50 grand, probably 90% of Americans couldn't afford a $50,000 denture to a full fix and maybe there should be a lower cost Chevy with many implants or couple with overdentures. You seem to be the master of that. I want you to address that question, why did minis have to be separated from implants in our profession?

Michael: Well, Howard, thank you. Those are excellent questions. First of all, let me just emphasize to you my congratulations for building an incredible network. The Dentaltown network is full of some of the most interesting people, they're so passionate about what they do. The ability for using that website to connect with people all around the country and the world is remarkable. I really congratulate you on that for being able to be a part of the bringing together of the community.

You bring up a very interesting point in terms of this discussion. I can't tell you how many times where we start interacting with other clinicians. It doesn't matter if you're a general dentist or a surgeon, whatever your training is is that we all interject a lot of our own personal philosophies and opinions when it comes to how I would treat a situation. Many times, I get e-mails everyday, almost 5, 10 e-mails a day about helping treatment plan cases for overdentures. I get a panoramic that just says, "What would you do here?" and I say, "I don't know, introduce me to the patient."

The number 1 rule of treatment planning is know your patient. There's this fantastic quote in implant dentistry and prosthodontics that says, "The first thing that you should do is meet the mind of the patient, not the mouth of the patient." Whatever sort of dentistry you do, the best modulator and best predictor of success is how well you involve your patient as well as communicate with your patient. It's true, when it comes to full-arch implant dentistry or any sort of restorative treatment plan, I love doing dentures, overdentures, narrow-diameter overdentures, full-arch fixed, full-arch metal-ceramic restorations. I look at a patient straight in the face and say, "My opinion is just to treat whatever you think is the best for you." I will show them every single option.

Now, I don't cloud them and just throw too much at them, I show them the model of this, this and this but it first starts with communicating. In many times, when you start talking to a patient ... Say, they have lost all their teeth, no problem, you have a few different choices, maybe to have existing complete dentures, what's the reason they're coming to see you. I'm doing pretty good with my teeth but when I'm out and about with my friends, I'm at the movie theater, I'm at dinner, I just don't have the confidence to be able to do this or that and sometimes I just leave my lower at home, okay, they might be talking about stability. Just adding a couple of implants whether it's 2 standard-diameter implants or 4 narrow-diameter implants, perfectly fine. I've done so much of that treatment with so much success either standard or narrow, it just doesn't matter to me but I have the opportunity to not only use a standard versus narrow-diameter implant in my practice from a few different directions.

Then also, I'll ask a patient and say, "How do you feel about your teeth coming in and coming out at night or during the day? Is that something that bothers you?" Many times, if they're an existing denture patients ... I'm doing okay, no big deal, I'll live with what I got. If they're transitional patients, somebody who is about ready to lose all their teeth. Many times, they'll say, "I don't know if I really want to have my teeth come in and come out." We'll probably stir more towards the fixed option but I'll still tell them about the overdenture option. Because let's be frank about this, yes, I understand we're providing a service that we don't always focus strictly on money but we're talking big bucks for our patients.

Many times, the difference between 2,500 to 5,000 is a moderate investment but to make the jump from 5 to $7,000 to 25 to $30,000 an arch is extreme. If you look at the literature that's associated with overdentures versus dentures, the literature is clear, the 2 implant overdenture option even when price is a consideration has such a huge benefit on quality of life versus the standard complete denture. It's approximately 4 times more expensive to go for 2 implant overdenture total cost versus the standard complete denture. Then when you look at the literature associated with 2 implant overdenture or 4 implant narrow-diameter overdenture versus a full-arch fixed restoration, yes, the cost takes another 4 times leap for total cost. The literature is not clear about the quality of life improvement, the full-arch fixed versus full-arch implant-retained restorations.

It's very difficult in the academic world. As you know, I live part of my life in practice, part of my life in academics. It's very difficult to convince academicians and universities to do research that's incredibly difficult and expensive, for obvious reasons.

There's this wonderful series of articles from the Jocelyne Feine Group at McGill University in Canada, looking at a crossover study of overdenture patients versus full-arch fixed patients. They started with one group with an overdenture and another group with fixed. At 6 months, they switched them over. At the end of 6 months, the fixed became the overdenture and the overdenture became the fixed. At the end of the next 6 months, they got to choose which of those 2 prosthesis they would want to live with for the rest of their lives. It's about a 50-50 split, who chose the overdenture versus the fixed.

That's really amazing because a lot of us in implant dentistry and especially those on Dentaltown, forget Dentaltown, anywhere, people have the mentality that we interject our own philosophy on our patient. Because I know you and I, Howard, we would look at this and we say, "I probably don't want to live with a denture." You and I would probably say, "No problem, I just want fixed, that's what I want to do," but we're also dentists, we say, "You know what? I just don't care how much money it cost because I see the challenges coming in with overdentures."

We have to empathize with our patients because, yes, we have to focus on giving them the best return and the best options but, sometimes, full-arch fixed is not the best for that patient because they might not have $25,000 to spend. Yeah, we can put in 2 implants in the anterior mandible or the anterior maxilla and convert them later to a full-arch fixed if we place the implants in the proper position. Or if we're considering narrow-diameter implants "minis" ... I can tell you, I've had such a good return on my investment with narrow-diameter implants, especially the ones that I use from Zest Anchors. They're amazing. Long story short, those implants in the anterior mandible, I have not lost a single implant and I placed a lot of those implants and I immediately load them all day. It's incredible, the results that I get. If I have a narrow ridge, I automatically go narrow-diameter implant for overdentures. It's just a piece of cake because I know my patients don't want to necessarily go through all the grafting and all the other surgery to do it.

I got to tell you, I don't understand the "mini" hate. A lot of it is leftover from earlier designs and part of it is, as I mentioned before, just our own philosophy interjecting. We have to look past that because there's wonderful options out there.

Howard: We talked to an oral surgeon in Germany. He told us 25 years ago, he placed a thousand implants a year and they're all root form. Now, 25 years later, it's 500 minis, 500 [inaudible 00:16:55], he's now half and half. Is mini-implant, not really the right term ... I noticed you use narrow-diameter and when you said mini, you put it in quotations. Is narrow-diameter implant a better term? Anything under 2.8 millimeter diameter is what you're talking about or ...

Michael: There's some debate there when it comes to the verbiage. There's this wonderful article from a researcher named [Bidra 00:17:21] that went through and actually define the definition between mini and narrow-diameter, and there's some crossover. If you look at the standard design like the IMTEC or the Shatkin style dental implant, those are minis. They are true mini implants because they're a single piece implant that's meant for a variety of indications including fixed versus removable. Typically, if you want to use them for overdentures, that's what the original design for.

The implant that I use is the locator overdenture implant. It's a 2 piece implant, that's a narrow-diameter implant. The reason is, strictly, when it comes to this, it's marketing in my opinion. Because I can't tell you how many patients that I've had coming to my office or at the universities that look at me straight in the face, Howard, and they say, "You're not going to put one of those minis in me, are you? I mean it." There is some philosophy out there from patients and they say, "The term mini makes it feel like you're doing less of a service for me." A lot of the marketing has been you just drill a tiny little hole and you screw it in, it's like placing a post and core, no big deal, anybody can do it. No, this is implant surgery, doctors. You have to treat this real. Part of what I do in our training courses like at UNLV and a variety of different training courses where we teach how to do these implants, you have to treat it like it's a regular implant. That's where doctors have more success.

Part of what I've done in my practice is say, "I have a standard-diameter implant for those normal ridge situations and I have a narrow-diameter implant for the narrow ridge situations." Patients look at me and they go, "That makes a lot of sense."

Howard: You're going to be listened to on this in 206 countries. In some countries like South Korea and Germany, 3 out of 4 dentists place an implant in the last 30 days. In America, 95% of general dentists have never placed one. To the Americans listening to you, why is that and how can they start? How do I get from I'm on the first floor, I've never placed one, I got to get to the second floor, what would be the first step? What do they need to do?

Michael: The first step, to give you a plug, is to get on Dentaltown and I mean it. Get on there, join the community, interact with the dentists out there. They're such great people on there especially on the implant forum that are willing to help, really willing to help. Part of it is that you just got to get past the initial [inaudible 00:19:54] mentality, the fear. You have to take some sort of educational initiative to really jump in.

Howard: Why did the Americans have more fear? Why do you think, specifically, American dentists versus Germany and South Koreans have dove in head first?

Michael: It could be related to the litigation system, it's hard to say. We're in a constant era of fear and you got to just go to one of these courses, no fear about it. When you go to a course that's given by one of the insurance companies, malpractice attorneys and they really hammer to you about all the medical, legal lawsuits about implant dentistry, it's true, you do have to be very careful.

The number 1 step that you should do is not just to jump into it haphazardly. Get in there, get educated, get comfortable and have a mentor, have somebody that you can partner with, either a training course, go through a university, something that's well-developed, maybe through an implant company ... There's a whole host of different implant companies that either had mentor-mentee relationships, whether it's through Dentaltown mentor-mentee or you seek an individual provider or practitioner. Heck, you go down to your other dentist down the street who's doing a lot of implants and you start hanging out at their office.

It's the simple philosophy of see one, do one, teach one. That's something that we learn in residency either in [a special training 00:21:22] or in a GPR program where you just got to see it a bunch of times and then you get to do one with the help of that mentor. Then when you do enough with them, you get to go and become the mentor yourself.

The educational triad, the see one, do one, teach one is so critical to my philosophy that I love teaching because of that. Not only do you interact with the most amazing dentists around the country ... In fact, I see pictures of people that come to my courses. There's one, I won't name her name ... I just got off the phone with her a little bit earlier, she's on the cover of the Patterson catalog. It's incredible. She took one of our implant courses at UNLV and now she's placing implants.

Sometimes all it takes is getting in there, having a couple of mentors, taking a formal course, putting in a few implants whether you do it here, domestically, or abroad, just get in there and just do a few to get that internal gut feeling remove from the system.

Howard: Your courses at Loma Linda and Las Vegas, your course where you teach dentists how to place implants.

Michael: What I do at Loma Linda ... I'm a professor in the prosthodontics department where I teach only the residents working with dental implants and also with surgery. At UNLV in Las Vegas, we do do surgery courses for general clinicians to come in to learn how to place implants either standard or narrow-diameter implants.

Howard: How do they get information about learning from you in Las Vegas?

Michael: You can go to the UNLV CE website, just type in Google UNLV Dental CE and it'll come up. There's a whole schedule that's on there.

Howard: If someone has never placed an implant ... You're primarily placing Zest Anchors 2 piece implants as opposed to a single IMTEC, Shatkin single piece of an implant. You're using a Zest narrow-diameter implant and it's in 2 pieces?

Michael: It is. I use standard and narrow-diameter implants in my practice. I also have a wonderful oral surgeon in my community that I collaborate with, especially for more of the complex cases for all on full-arch fixed and as well as routine cases. I believe in collaborating and then also doing some of yourself. I place a lot of the Zest LOCATOR overdenture implants, plus I also do place the Biomet 3i system because I absolutely love something called the Encode. Encode is just incredible. It's, basically, a healing abutment. It has a couple of notches on the top that allow me to do a digital scan. The healing abutment stays in the mouth after the implant has been placed. Then after integration time period of approximately 8 weeks, patient comes in, I don't do anything other than use my digital intraoral scanner. Then next time the patient comes in, I remove the abutment and the crown goes on. It's magic.

Howard: Wow. How do you want to start this discussion? Somebody is driving to work right now and my average listener ... Podcasts are about multitasking. Most of them are doing it on the hour commute to work, rural, urban, it doesn't matter, then a smaller percentage are doing it on the treadmill or either I'm washing dishes and doing laundry outside. I never placed an implant and I got this lady, and the best one would probably be your grandma or a relative or a cousin or uncle, how ... Talk about treatment plan. They've heard Hader Bars, Dolder Bars, they heard all this stuff. Talking to your prosthodontic journey, how should they look at this denture? What would be a good entry level search? Should they be doing 2 overdenture, Dolder Bar, Hader Bar? Just take it away.

Michael: Sure. What is really the most bang for my investment time both monetarily as well as emotionally in my own practice are first molars and upper bicuspids. Without a doubt, the implants that we do the most work with are 3, 14, 19 and 30 as well as upper first or second bicuspids. If I were to pick any implant for a clinician to place their first implant, it would probably be one of the upper 3 teeth meaning first molar, second premolar or first premolar. Those absolutely the best implants to start. Somebody with a high sinus that's already been extracted, you have a nice ridge waiting for you. Your first immediate placement implant should be a maxillary bicuspid, without a doubt.

Where clinicians get into a tricky situation is when they want to do tooth number 8 and number 9 as their first one or somebody that's just very particular, you think, "Second lower premolar, perfect. Circular root, amazing." Remember, you got a little scary device sitting right next to that second premolar called your [metal framing 00:26:28], you want to be careful there. I won thousand percent of the time advocate for a cone beam CT. Without a doubt, in my own personal practice, it is my standard of care. Now, I'm not advocating the standard of care is cone beam CT for every practice, not in the least of it. Your first few cases should always be with the cone beam whether it's a single implant standard-diameter or for full-arch implant overdenture cases.

A part of our training course at UNLV was working with clinicians and doing that. We split the group, half of them placed single implants, the other half placed implant overdentures as their first patients. It's split, they both do fantastic. We had to really really pick our implants. They're always upper bis, there's a couple of lower single first molars, always we had a cone beam and we treated them just like our students at UNLV or at Loma Linda where they have to come and do a comprehensive planning session, PowerPoint, CT scan, bone analysis. 90% of implant dentistry is the workup and the planning. Anybody can get in there and just go, step 1 through 5, drill the little screw and you put the thingy in the bone, piece of cake. Sorry, we're all surgeons, it's true. The moral of the story is where people get into trouble is in treatment planning. Because we think of it just routine, everyday procedures where you go, "I got a crown prep here and an amalgam here. Everything is good. I'll feed in that implant, the patient broke it off, it'll be done." That's when mistakes happen.

Now, if you're established, you've been doing implants for a long time, you don't need a CT scan. Your first 2 cases, it's all about taking that stress factor away. Guided surgery does that as well. Even though I'm not the hugest fan of guided surgery for every situation, it's a wonderful system so that you have something to lean on for that first case. It gives you that little extra confidence to know that, "I'm going to nail it." You got something to fallback on whether it's your mentor or your guide.

Howard: Are all CBCT the same? Is there any one you like more than others for the general dentist?

Michael: Everything is pretty much the same. It's really coming down to a price battle right now. I think still the standard ... Really, one of the best CT scanners out there is the i-CAT. It's a wonderful system but 150 to $180,000, it can be a heavy hit.

I get this question a lot. I don't have a cone beam scanner at my office, I want to get into narrow-diameter implants, I want to get into overdentures but I'll just take a quick panel. There's a wonderful website called CONEBEAM.COM. You type in a little zip code of where you live, it'll give you the reference of all the places in your area where you can send your patient to, whether it's a scan center ... If you go to the Bay Area in San Francisco, there's several amazing scan centers there. One of them is Reveal Diagnostics, they're incredible, they work with a lot of clinicians. Then you look around your area, a wonderful resource for you to send a patient to is your orthodontist office. Almost every orthodontist that I know right now has a cone beam. I understand you might get nervous about sending your oral surgeon or your periodontist to do a cone beam, they're like, "How come you're doing these implants here?" No, avoid that. Send it to your orthodontist, get the case rolling, get some more information.

Howard: Who's behind CONEBEAM.COM?

Michael: That, I don't know. I don't know who runs that site. I just recommend it just because it's a wonderful resource for clinicians, especially that little map search tool.

Howard: That is amazing. Then on the cone beam, how do you learn how to ... The surgical guide. You have a cone beam, you're doing a surgical guide ... On Dentaltown, there's all kinds of different threads about all kinds. Some of them like the CAD/CAM, Galileo's can take the image and help you mill out a surgical guide. Is it BioHorizons? What surgical guides do you like?

Michael: I use them all. The only one I don't really like is the Cerec one just because ... Again, I'm probably going to get flamed on Dentaltown about it but I don't have a Cerec in my office. There is one sitting up in the closet upstairs, it's an older unit. I don't use it. Why? I just don't really want to. It's just too much work for me to do, it's too complicated. To tell you the truth, when it comes down to it, doesn't matter what your surgical guide system is, you just want it to have as simple as possible. The stuff that I use ... I've used literally every single guide system on the market. I really love the Anatomage guide. The Invivo guide, that's a wonderful guidance system. SIMPLANT is a wonderful guidance system. There is a wonderful guidance system out from the nSequence laboratory in Reno, Nevada. Daniel Llop has a wonderful approach to full-arch fixed cases there. I've done quite a few of those cases, they're incredible.

What it comes down to is you can also check out ... Just a quick plug, Howard. I got a DVD series coming out on guided surgery that I co-authored with Dr. Doug Chenin and Dr. Justin Moody, who Dr. Moody is ... He's a big BioHorizons user as well. Dr. Chenin runs educational software as well as resources for doing cone beam imaging.

I love cone beam. I love surgical guides. It has its limitations. I'm a big fan right now of using the Invivo guide with a pilot hole only because I want to be able to get that initial hole and then the rest is done freehand. I do the same thing with my Zest Anchors, the surgical guide system for them. I helped develop the guide surgery system for them as well.

Howard: How many hours is your DVD? What's the name of it? What does it cover?

Michael: The company is called Clinically Correct, just go to Google and type in Clinically Correct dental company. It's a 3 disc series, DVD, that has a whole host of different information by myself, also Dr. Moody and Dr. Chenin, all about cone beam imaging, all about the information associated with it. It's a few hundred hours. You go buy the DVD series, they'll send it to you. It's, literally, everything you've ever wanted to know about surgical guides.

Howard: Clinically Correct, this is just for surgical guides?

Michael: They don't make the guides, it's just educational-

Howard: No, I mean your DVDs.

Michael: Yes.

Howard: Okay.

Michael: It's also cone beam analysis as well.

Howard: Do you have a WWW for that without a Google search?

Michael: Yeah, let me get that for you. It's clinicallycorrect.com.

Howard: I should have guessed that. How many hours long is it in its entirety?

Michael: Let me just pull up the website here. It is a 4 disc series, excuse me. It's going in presale right now and it'll be available in September. September of 2015, it's available. The retail price is 595. It's a 4 disc series, it covers everything from single implant to multiple implant guided surgery. Part of what-

Howard: How many hours were those 4 discs be?

Michael: That, I don't know. I could not give you that information. I know I contributed 2 hours myself, I think Dr. Moody did 2 hours and Dr. Chenin did somewhere between 2 to 3 hours, somewhere in that range. Just under 10 hours or so.

Howard: 10 hours. What would be a great marketing? Is when we're done, have Dr. Moody e-mail me at howard@dentaltown.com and Dr. Chenin and they'll also do a podcast talking about this. That is amazing. It's just a great way to get information, DVD, and learning at home. All the research I'm showing is that humans love to learn in small segments as opposed to just like going to a 10 hour course at one time. By hour, 6 or 8, you're probably just fried or tired. To be able to listen to an hour here, take a nap on Saturday, wake up, do another hour later that night-

Michael: Just let me interject one second. It's perfect. I know I personally believe in that philosophy as well because I do have 3 YouTube channels on the topic of implant overdentures. It's interesting because I used to generate hour-long videos and very comprehensive, very detailed, step-by-step for the surgery as well as the planning step. I found that most of my YouTubers were tuning in approximately 14 to 16 minutes. The attention span is there but you got about 15 minutes to really nail it. Most of my videos that have been coming out lately are somewhere in that range because I know we're busy clinicians, we don't want to spend the entire hour. I still do the hour-long segment videos because there's people out there like myself that say, "I'm getting into my first case, I want to know as much information as possible," but there's also people that are just like, "Click, click, click, I'm just going to do this quick video."

What's really cool is is that I've had academicians, meaning academic people from all over the country and the world, e-mail me and say, "Hey, is it okay if I show you your locator pickup technique video in my course at the school?" I said, "Of course, you can." That's my number 1 reason why I've done these videos so people out there can just try some different techniques.

Howard: I'm amazed at how many dentists ... You just said YouTube channel. Most dentists don't know what you just said, they never heard of a YouTube channel. Explain what a YouTube channel is.

Michael: It's fantastic. You just literally type in your web browser YouTube.com and you go to the search box at the top and you type in the most random idea that comes into your head. Say, you want to learn about Zest Anchors implants, you type in Zest LODI or LOCATOR and then you'll find all these different videos of how to do a 2 implant overdenture pickup in the mouth. Or if you want to learn a technique of how to place 2 implants in the mouth or if you wanted to learn how to do sizing for the tissue measurement for how high your locator should be, it's all in those videos. Say, you wanted to learn about a zirconia dental implant, there's so many videos out there with surgery techniques on YouTube. It's really really incredible. The social aspect of people going on to this site, YouTube, for free posting a video for people just to watch their technique. It's just incredible. The sharing economy that's going on right now, especially here in Northern California, is just amazing. What you're doing with these podcasts is amazing too. You're sharing, this is the sharing economy.

Howard: They said if you were born the same day Jesus of Nazareth was and listen to YouTube 24 hours a day for 2,000 years, you wouldn't have listened to all the YouTube channels.

Michael: That's very statistic.

Howard: Amazing. You and I are both educators and we're trying to get them, a thing we have to remember though, a lot of them don't want to learn unless they get credit for their status in society or whatever. I've always thought about your amazing YouTube videos. You've already done the work, you should repackage them into an online CE course where we can tie them up an hour where they can get AGD, ADA credit. You've already done the work and if you were to repackage those, I would just kill to have some of that course. Because those online CE courses, they pass 550,000 views and I think a huge part of it is because they get credit for their continued education or they're trying to earn 500 hours for their FAGD or another 600 hours for their MAGD or at least the ... Not the hands on part, 400 hours, but the 200 participation. If you ever have the time and I know you probably don't but you want to wrap any of those up in the online CE course, that would be great.

I want you to address this. My job is to try to guess questions for people that [I'm talking to 00:38:52] right now. They've heard Hader Bars, Dolder Bars, talk about where ball and ring locator versus a Dolder Bar, a Hader Bar. Are those passé? Talk about that.

Michael: I wouldn't call them passé but if you went around in a room of clinicians and a large audience and you ask them, "How many of you are still doing bar overdentures," there's going to be a couple. The number used to be much larger a long time ago. The reason for that is that, number 1, it's just much more complex and, number 2, it's much more expensive. If you have 2 implants in the anterior mandible and if a bar and clip overdenture has been proven to be better over and over and over again, then the money is probably worth it either to pass it along to your patients or just to eat some of that cost yourself to do more cases. The literature is pointing in the opposite direction. The literature is actually showing that the 2 implant, single, individual implants like stud style connection, like a locator, patients prefer.

When you really look at what that impact has versus the cost of doing that versus a bar overdenture, it's stunning. For me, just to do the bar, you're probably adding an additional $2,000. Easy. When you think about a locator, you can buy the locator, it's $129, $170, somewhere in that range depending upon your implant company, times 2, you're saving big bucks. Then on top of it, as you were saying before, there's this one big thing that's coming to implant dentistry that people just go ... They look at something and they say, "That just looks too complex."

Zest has really nailed the locator because it's so simple and it's so easy to maintain. How many of us have done a realign with a bar? I sometimes, in my course, has asked the question. How many of you want to do a realign for a 4 implant bar overdenture right now? Sweats starts dripping down the brow.

Howard: I've actually had a nightmare before, a real nightmare, the [locking on 00:41:07].

Michael: It's true. Well, doing a realign for 2 or even 4 implant overdenture on a locator, you'll go, "No sweat, I'll be done in 15 minutes." It's just so simple. Then the changeout of the little inserts, you're done in about 30 seconds. Then what's really great about it is you have 6 different types of retention mechanisms for the locator, 3 for the standard range and then 3 for the extended range, you can mix and match. That's powerful.

Howard: Here's what's hilarious about it is ... I can't tell you how many times you go watch a football game with somebody, a dentist, and they'll say, "Oh my god, I did a realign on this lady. I mean, she's been back 7 times." I started thinking, "You're mad at the lady, she gave you money, you did a solution. She's been back 7 times, maybe it's you, Doc. Maybe you shouldn't have done a realign, maybe you should have place some narrow-diameter implants." Who's really to blame here?

Michael: Without a doubt. Clearly, across the board, more implants are usually better for patients. If I have an opportunity to place 4 narrow-diameter implants in the anterior mandible or 6 in the maxilla, holy cow, what a wonderful solution. I do tend to lean in the direction of 4 implants in the mandible as opposed to just 2 for an overdenture but if I have a patient that's just really more medically complex, maybe doesn't have the bone, you're starting to get nervous as you get close to the [metal framing 00:42:35], clearly 2 implants is fantastic. It's a wonderful, proven treatment modality.

You bring up an interesting point, Howard. Apart of some of the courses that we've done or a lot of the courses, we have a hands on exercise for doing the locator pickup. A lot of us will look at that and they'll go, "Piece of cake. Come on, I don't want to do this exercise, just show me the surgery, that's what I came here to do." I got to tell you, Howard, how many clinicians inadvertently make silly little mistakes when picking up attachments for a locator? I maintain that the vast majority of complications with overdenture prosthesis is technique for attaching the denture to the implants. A lot of it comes down to the simple thing.

This is one thing I bring up in the courses is ... It's funny. If we take a denture and, say, your denture is like this and I go, "Okay. Well, I'm going to have ..." This implant is being picked up. I put my stuff in here, I sit it in the mouth, what do we normally tell our students in dental school to do? They bite down on the denture while the resin is curing. If you think about it, how many dentures have you done where you have the patient bite down and they bite down crooked? There you go, Doc. Here's how I bite. All right, bite down. They're touching their anterior teeth. It's true.

The same thing with dentures, all it takes is them biting a little bit crooked in the different direction and they're putting more pressure over here than over here. When they do that, what happens is the denture lifts just a little bit like this, maybe only 100 microns, 150 microns is all it takes. Then all of a sudden, you're locking the 2 locators just a little bit, this one is a little lower, this one is a little bit higher. All of a sudden, you take the denture out, it's connected. You pop in the blue locator and you go, "This side is perfect, this side just pops out a little bit too easy for me." What do we all do? Take out the denture, I got a solution for that, you change it out, you put in the pink one, "It fits a little bit better, still not there yet." Hold on, I got a solution. Pull it out, put the clear one in that side and you go, "Got it. All right, perfect," out the door. Then all of a sudden, they come back with wear on this side.

A lot of it is technique. What I do is I have the material injected into the denture and then you just lightly hold it. That way you're ensuring that the denture is sitting down completely on the tissue. We're making an implant-retain denture, not an implant-supported denture. When you have an implant-supported denture, you're putting wear on the components. As dentists, we know that whatever we put in the mouth, the patient is going to figure out a way to screw it up somehow. That's part of life. You try to engineer in a way like with the locator abutment and the locator denture components, the engineering for wear is on the non-retentive part. How the locator pivots? That little pink or blue clip that goes on top of the locator is firmly anchored to the locator and the cap pivots over the top.

Howard: When someone [inaudible 00:45:39], do you like an all new denture or do you retrofit this under 10 year old existing dentures?

Michael: Both. If I have an acceptable, complete denture and I have a patient that has an acceptable, complete denture, I'll say, "Listen, I can make you a new denture, I'll be happy to do that. You know how much I love making dentures, that's the reason why you're here. To tell you the truth, you got a pretty good denture. I can just convert this over. We'll do a realign and be done with it." They look at you like you're their hero. You tell them, "No problem. Maybe in a couple of years, we'll make you a new denture once you're wearing out this a little bit more. I'm going to tell you, once I put those implants in there, once I connected to your denture, you're going to be enjoying that thing more and wearing it more. Don't worry, they'll come back in later."

Howard: Yeah. You are their hero. The dentist doing the realign where she's back on your door 5 times in the next 12 months, you're not being their hero, you're not stepping up to the plate. This isn't technology that came out yesterday, you should be on this. I'm thinking, someone also might be asking, Dr. Scherer, why do you like a 2 piece Zest Anchor as opposed to just a 1 piece Shatkin or 3 IMTEC? Why do you like the 2 piece better?

Michael: I like the 2 piece because ... Let's be frank here. I just mentioned that we're going to have some wear in the mouth, there's going to be some problems later on. Nothing against any of the other implant systems, they're all very good implants. What I really like about a 2 piece implant is that in the mouth, something is going to break down, you're either going to get wear, you're going to get some sort of damage, an implant can break or the abutment can break, who knows. If I can change the top part out of the implant and put a new piece on, say, something happens later down the road, perfect. What's nice, also, about the Zest implant is you have a few different cuff heights when it comes to changing the tissue height of the narrow-diameter implant. If your tissue swells back all the way down and it's very thin, your implant is too tall, you can change it out to a smaller height. That's something you can't do with a 1 piece dental implant.

Howard: I want to ask another question. When we're talking about the raise of edentulism ... I don't know if it's different here because I'm in Arizona, I'm 100 miles from the border. United States gets a million immigrants a year and when they come across the southern border, that's the sticking point from [inaudible 00:48:09] world. I'm seeing a lot of edentulism from immigrants. I think the last denture I did, they actually were from Bulgaria and went to Central America [inaudible 00:48:21]. Then also, meth.

My questions to you are ... In [Bakersfield 00:48:29], I have read, is pretty much the meth capital of America. I hear there's more ... My dentist friends who are at my age, even ones that I graduated with, said that when they went to [Bakersfield 00:48:40] in '87, they hardly ever did a denture. Now, they're doing dentures all the time because meth is crazy explosion. Out here in Phoenix, Arizona, we got a suburb called Apache Junction. My police officer patients say that every single trailer park in Apache Junction has a meth lab in there somewhere, it's just a matter of how much time you want to spend finding it.

Here's my question. If someone lost all their teeth from meth and they're still using meth, is that going to be ... How does implants work with someone who lost all their teeth from meth because meth users usually don't stop?

Michael: That's the hardest thing too. When it comes down to it, number 1, we're still doing surgery, we're still changing that person's life. If you have an active drug user that's a patient, I certainly would not treat them surgically. I don't think that's wise. I do have some patients that do come in because of amphetamine abuses and different types of medicines. It's not just meth, it's a whole host of different medicines, paraphernalia and drug uses. Clearly, the mouth breaks down. The good news is that the bone is still the bone. Once you take all the teeth out and implants go in, there is no literature that I can think of that will show that implants have a higher degree of failure in patients that have a history of amphetamine abuse. That research might be out there, I'm just not aware of it. What I do know is that those patients, many times, have extensive dental means, dental decay, root fracture, infections that can benefit from a complete denture. Those are the patients that once they get their act together can have a substantial life improvement.

Many of the times, they are younger as well. We have to start thinking about treatment planning our patients for today and tomorrow. If we place our implants, say, in the canine position like we're taught in dental school and it's a 22 year old patient, you placed 2 of them, 22, 27, you make upper, lower overdenture. Patient has reformed, they stop their drug abuse, everything is fine. Now, 20 years later, they say, "I'm tired of the denture. I'm now reformed, I got a successful business. I wanted to spend a little bit more money, I want something fixed." If the implants are at the 22 and 27 position, it's very difficult to make a full-arch like All-on-4 type restoration because you don't have a lot of room posterior to place implants. If you place implants, say, in the lateral incisor position, you have plenty of room in the posterior mandible to place additional implants for an All-on-4 or [DM type 00:51:20] prosthesis. Or if you place implants in the posterior position like in the first premolar or second premolar area, you can always add implants later on for a fixed. I always advocate treating for today and also for tomorrow.

Howard: Speaking of All-on-4, one of the things you always hear in Dentaltown, people will snidely say, "Yeah, but All-on-4 means none on 3. You don't have any spare tires. One implant fails, we lost that arch." What do you say to that comment?

Michael: I'd say, it's completely ridiculous. I make no qualms about that. That's a philosophy that I use to hear in different parts of the country, different schools. I tell those people that you really should look at the literature. There's an original treatment philosophy called the Brånemark Novum approach where they would actually use immediately loaded All-on-3 restorations. It was proven, it was very successful, it was All-on-3. Then, also, there are some very interesting data coming out of some of the Italian groups where they're doing All-on-2. They're doing 2 implants distalized in the canine position and they're placing a full-arch fixed restoration on that.

Now, if we maintain a dogmatic philosophy, "That's just my philosophy, that's just what it is. I'm not going to change it," I'm going to tell you that this is my approach, I found it to be successful, I stand on the literature. Steve Parel had an amazing article in general prosthetic dentistry a couple of years ago about his high success rate of All-on-4 restorations. If you lose one, the prosthetics are viable, still 100%. You take out the implant, you put the new one in and you're done.

Howard: Very good. When I think of you and ... Like I said, I'm a big fan of your YouTube, your posts. You're also, really, a technology guru. Talk about digital technology, intraoral scanning. What do you mean by open STL files? Is 3D printing ... Is that Star Wars 7? Is that around the corner? Is it here today? Can you talk about technology for a little bit?

Michael: I'm, literally, addicted to the latest technology that's been out. It's amazing. The thing is is that I really am just a computer nerd that just happens to become a dentist and that's the truth. I, literally, no longer use PVS in my practice ever again, as long it's just for complete dentures and that's it. Everything else is the digital pathway.

The challenge that I have that I advocate for other clinicians is to be able to do it in a way that's effective both clinically and also cost effective. That's my problem also. Sometimes when you look at some of the fancy technology like Sirona Cerec ... It's a wonderful system. Nothing against it, it's just not right for me. I don't want to spend $120,000 on a system that I, then, have to literally change my entire practice so that way I can become a [inaudible 00:54:16]. I want to be able to say, "Instead of giving me the triple tray full of PVS, give me the wand." I got to tell you, Howard, if I had to go back to using triple tray in PVS, I would stop practicing crown bridge dentistry. I make no joke about that.

It, literally, has taken my impressioning stress level to 0. Because you're an established clinician, you've been around, you know what doing crown bridge is like. Other clinicians that are watching, you know what I'm talking about. You got that pain in the butt patient, she is just ... The tongue, and you're trying to prep, it's a mess. You pack the [core 00:54:55] and she's going, "What are you doing to me, it's hurting," yada, yada, yada. Then you get out the triple tray, you inject the stuff, the tongue is doing that again, and then you go, "All right, bite." Then your heart is going ... God, please just get that margin. Then 2, 3 minutes later, your assistant comes to you with a triple tray and your heart is beating like ... You go, "Darn it," and you got to go back. Or even worse, you look at it and you go, "It's good enough." No, no, no.

With digital scans, you literally go like this versus this and you go, "Don't have it yet, don't have it yet, don't have it yet. Hold on, Mrs. Smith. I know it's stretching. Got it." You know definitively, within about 45 to 50 seconds, that you have your impression. It's incredible. The accuracy, the precision, I will literally never go back. In my office, I use 3M True Definition Scanner. I love it. I don't care about powder. All the Dentaltown people out there, I know you get excited about powder, get over it. Powder doesn't matter to me. In an ideal world, if I can skip the powder and still get the same accuracy, that'll be fantastic. Powder, just a light dusting, gives you higher accuracy and tighter standard deviation.

If you look at the literature out there, everybody gets excited about Cerec, everybody gets excited about a TRIOS scanner, I tell you those are wonderful devices but ... They are accurate but if you look at the spread of the accuracy, it's a very wide standard deviation. Where if you look at something with powder like the True Def Scanner, the accuracy is very tight. Howard, I can talk about it all day because I just love it. I do some pretty bizarre things with it including 3D printing in my office.

Howard: You have to use a lab then that uses, at the other end, the 3M True Definition Scanner?

Michael: Sort of. It's pretty easy for laboratories to get involved and there's quite a few laboratories right now that allow the digital scans to come in. All they have to do is contact their 3M rep or they contact whomever they work with. They just download their little margin marking software and that's it. What's really cool about that type of scanner is it literally sends you something that looks something like we're used to working with, a simple model. When you look at that simple model, it comes back something like the laboratory has used to working with. It's a die. They do their standard PFM technique with this model and that's what's really great. I don't want to say that all ceramic restorations work everywhere. I'm pretty conservative when it comes to my dentistry, I still really like PFM. I play with zirconia, I like monolithic zirconia in the posterior mandible but in the anterior, PFM. It's beautiful.

Howard: Explain to the dentists how the lab ... Okay, the lab receives this on the other end like on their internet, on their desktop computer. How does the lab take it from there? What are they doing? Is this 3D printing?

Michael: It is. With most of the scanners right now in the market, what they do is they get this STL file, it's uploaded to them. Within about 5 minutes of clicking the button on my scanner, it's already at the laboratory. Then the laboratory technician gets the file, they open up the software and they go, "Here's the margin," they mark it and then they slice the dice just like they would normally do. Then they issue a command and it's sent to an industrial grade 3D printer. It's printed on an articulator just like this removable dice. If I wanted to remove the die, there it is. Then it comes back to the laboratory with the triple tray just like what you would see here. They were very used to working with die models that look like this. You wax up on it, you cast the coping and then you check the occlusion. It's, literally, no different from their current workflow using this technology.

That's where it's an adaptive technology as opposed to disruptive. Because if I can do something instead of saying triple tray PVS, impression wand, same thing on the laboratory side instead of saying impression triple tray PVS, digital file, 3D print, everything else is the same. If I still want to do my tried and true PFM crowns, I do that. If I want to do monolithic zirconia, I do that. If I want to do lithium disilicate like e-max, I do that.

Howard: Some of these labs are saying ... Since I don't have to pay a person to pour up the model, trim the die, do all that stuff, some of the labs are actually giving you a discount if you use that. Have you seen that?

Michael: I have.

Howard: Have you seen that? What labs are you using?

Michael: I use a variety of dental laboratories. I really like Precision Dental Arts in Idaho. They're a wonderful digital lab. Also, I use Advantage Dental Laboratory in Tallahassee, Florida. They're incredible for aesthetics. Then I also use California Dental Arts here in Northern California. All 3 of those labs are incredible. I've used Arrowhead before, they're an incredible laboratory as well. I know a lot of clinicians really love Glidewell. It's a fantastic lab, they are super digital as well.

Howard: If you have any buddies at any of those labs that want to do a podcast about the other end ... I mean, you're the prosthodontist sending it. If one of your buddies wants to do an hour about receiving it and all that, I would love to do a podcast on that.

Michael: I'll surely pass it on.

Howard: Did you believe this? Some labs are saying that when you ... They get a PVS and they have a human pour it up, trim the die, whatever, they're averaging 6% remakes. When they have optical scanning like you're talking about, it reduces it to 1% remakes. Do you believe that?

Michael: A thousand percent, 120,000%, whatever you want to call it, without a doubt. I can clearly attest to that too. Because I've had a couple of situations where the laboratory technician may be ... Even on the digital side, you still have a human component. The technician said, "I think that's your margin right there," it comes back and I look at that and I say, "Try it in the mouth, nope, they miss the margin." In our traditional crown bridge world, if you miss the margin, they've already pour the die, your first pour is the most accurate. If you have to remake the crown, you got to [core 01:01:35] again and make a new impression.

With the digital world, I say, "I'm sorry, your crown ... I just got to go back to the laboratory. There's a couple of things that need to be change." "No problem, I'll see you back in 2 weeks." I call up the laboratory and say, "Remember that file I sent you, go ahead and remark the margins. You just miss this little edge, send it for 3D printing." It's the same file, it's perfect. Then they make 1 minor change and it's corrected as opposed to having to redo the entire impression. That's incredible.

Howard: In the economics [inaudible 01:02:08] Arizona State University, in economics, we say, "Price is for 4 out of 5 answers." On the 3M True Definition, how much does the system cost and is there a cost each time you take the impression?

Michael: No, there is no per click fee. The scanner itself is approximately $15,000.

Howard: 15?

Michael: $15,000. It's the lowest price of all the scanners on the market right now. That's the big reason why I was leaning in that direction. Forget price, when it comes down to it, I still need something that's accurate. It is the most accurate scanner in the market, it just happens to be the cheapest as well. I looked at some of the other expensive scanners. You can get a scanner anywhere from 25,000 to $55,000 for a scanner. When I looked at that, Howard, I say, "Well, most clinicians could afford that, no problem if it was that much better." In all reality, I would love to be able to say, "I can get out $40,000 cheaper and still have the same quality in my practice," and that's what I've done. Every system, pretty much, has a yearly fee where you have to keep their software up to date and then also pay for certain amount of applications. When it comes down to it, you can't get away from it. It's usually a couple of hundred dollars a month, somewhere in that range. Some are higher than others.

With most scanners, there's only 1 or 2 in the market that have a per click fee. The scanner I use does not have a per click fee. I would not use a scanner that has a per click fee because it creates this incentive for me to experiment a little bit at my office. I'm a computer nerd, I experiment a lot. I scan just for fun and then I 3D print in my office and use some bizarre things like here's a 3D printed denture that I just printed.

Howard: Are you printing anything for clinical purposes or just hobby purposes?

Michael: Well, it's tough right now because, currently, the in-office 3D printers that are rated for using for real purposes are incredibly expensive.

Howard: How expensive?

Michael: Usually, at the low end, about 16 to $18,000. On the high end, 85,000, somewhere in that range. If you're a dental laboratory that depends on 3D printing for your crowns, your dice, your margins, spending that money is worth it. Say, you have a production lab, you want to generate surgical guides, to spend $20,000, it's just what you have to do. For me, what I use it for is kind of playing around a little bit but also with some seriousness.

Something as simple as ... Like this patient, she had mobile anterior teeth. If I made an alginate impression, I would have extracted the teeth. I scanned her, 3D printed her teeth and then it allows me to do a simple vacuum formed matrix on the top. That way, the next time I see her, I have something to make a temporary with. I extracted the 4 incisors, prepped 22 and 27 and now I had a vacuum formed matrix for a temporary based upon my own 3D print. In my own office, that 3D print cost maybe $5. Where if I send it to a laboratory, a model like that sometimes cost 25 to $35, somewhere in that range.

Howard: I don't want to get you in trouble because you're not supposed to speak for your spouse but you did say, at the beginning, your wife is an orthodontist. Is she orally scanning for indirect like Invisalign or ClearCorrect? Is she doing this ... Do you guys share an office or do you have 2 separate offices with separate equipment?

Michael: She has her own office. She works at an orthodontic practice here in Sonora. Then she also does some [per diem 01:05:53] type work at some different offices around California just helping out, little [inaudible 01:05:58] type dentistry. She does scan quite a bit for Invisalign. To tell you the truth, it's very effective for her but, also, it's pretty quick and pretty easy to make an alginate impression. Speed and efficiency wise, it still is a little quicker to use an alginate for a retainer for the upper and for the lower. When it comes to what I do on the crown bridge side or the implant side, it's much faster to use scanning. There's still some limitations there for scanning but you can get a whole arch scan in about 60 seconds.

Howard: I got to wrap this up for you. I'm just honored you gave me an hour of your time, you're so amazing. What would you say ... A big amount of the people consuming my podcast are young dentists, a senior in dental school, just got out, what would you say to a kid who was sitting on the fence of whether to go to general dentistry or go do a prosthodontic residency ... Like you're a prosthodontist, what do you say about that decision?

Michael: Well, the challenge is, in today's day and age, to consider the costs of dental education. It's very difficult right now, the thought of spending an additional 3 years in residency after 4 years of dental school when you have over $400,000 in student loan debt. That's a challenge, especially if you have a family. Many times, you do have to start working right away to start paying for your family and your expenses. My direction in life was to try to be the absolute best that I could be, the scientist that I could be. I just really personally felt prosthodontics was my calling because it allowed me to explore the science of things. I was a general dentist for 2 years before going into prosthodontics. I love general dentistry as well and I encourage you ... If that's your passion, stick with it. My passion was in implant dentistry as well as full-arch dentistry overdentures and dentures.

For me, I had too many questions out there that CE could not answer. What I spent 3 years of intense learning in residence in Ohio State with my team and Dr. [inaudible 01:08:09] and all my co-residents, the lateral learning and all the learning that we do is just worth so much in continuing education dollars. Unfortunately, they're just not the world's best education out there for things that I want to do in a regular basis like complete dentures. I just felt the calling to go back to prosthodontics. Also, it allows me to become an educator, to be at the universities, to do bizarre things like this in my life where I can 3D print somebody's mandible in my own office. It's incredible.

I know we can all do that as general clinicians. There's quite a few out there on Dentaltown that are doing some very inspiring things. I have a passion for prosthodontics and I wouldn't change it for the world.

Howard: What if these listeners want to get a hold of you, are they able to communicate with you in any way?

Michael: Absolutely. You can certainly send an e-mail address, I give that out, it's M-D-S at S-C-H-E-R-E-R.net. My 3 initials, Mary David Smith at Scherer.net. Or you can always just find me on LinkedIn, I have a profile on LinkedIn, Michael Scherer. Or you can always call me at my office phone number, 209-536-1954. I encourage it.

Howard: Any chance our listeners might ever get credit for taking an online CE course from you on Dentaltown?

Michael: Absolutely. If I had the [invitation 01:09:28], I would be happy to do one for you.

Howard: It would be the hugest honor. I think you are so damn cool, so smart and so amazing. I think it would just be amazing. Plus, you already got all the material on your YouTube channel. Most of that will be a matter of just repackaging existing stuff that you've already done.

Michael: One thing we can always do is just be able to have incentive for CE. Now, I still do believe in having open channels and easy accessibility for anybody and YouTube channel is a big passion of mine. If there's anything I can do for Dentaltown to help you out, it's such a wonderful resource. What you do, Howard, and what you've done with Dentaltown, it's so admirable. I thank you for being able to contribute to clinicians around the world and to be able to educate. The indirect vision of what you've done with Dentaltown is so incredible.

Howard: It's incredible only because of guys like you who are sharing. That was from Dr. Scherer. Thank you so much for an hour of your time. You just rock my world. I bet all our listeners are going to probably play this one over 2 or 3 times.

Michael: Well, Howard, it's a pleasure. Thank you for your time and thank you for everybody's time for tuning in out here. It's a pleasure.

Howard: Anything you want do with the online CE, we just would love it. Dentists need to stop complaining about the realigning lady coming back 5 times and start stepping up your game so that grandma never has to come back and you can increase her quality of life and be the hero that you should be.

Michael: I tell you, you do good dentistry, you look at a patient straight in the face with confidence and conviction and say that something is going to change their life, believe in it. Implant overdentures will change their lives. The patients will be walking out, money on the table in your practice as opposed to walking down the street.

Howard: You make money and think of all the money she'll save by not having to do $50,000 All-on-4, which 9 out of 10 are never going to buy anyway. I mean, you're not losing any money if grandma can't afford it. If grandma can afford $50,000 All-on-4 and you're not offering a $5,000 solution, come on, step up your game.

Michael: In my practice, I have literally gone crazy with overdentures. Many happy patients, it's incredible. To tell you the truth, some of them will turn to All-on-4s, you'll have that opportunity but treat your patients like you would want to be treated and you will always have success.

Howard: We will end on those words. Thank you so much for your time, Dr. Scherer.

Michael: Howard, it's a pleasure.

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