Dentistry Uncensored with Howard Farran
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333 Sinus Lifts with Radoslaw Jadach : Dentistry Uncensored with Howard Farran

333 Sinus Lifts with Radoslaw Jadach : Dentistry Uncensored with Howard Farran

3/13/2016 12:59:33 PM   |   Comments: 0   |   Views: 842


333




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VIDEO - DUwHF #333 - Radoslaw Yadach



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AUDIO - DUwHF #333 - Radoslaw Jadach


This episode’s discussion:

1. Three stages of knowledge

2. Surgery as traffic

3. Competition

4. Blood and adrenaline

5. And much more!


2001 - Graduated from the Faculty of Medicine and Dentistry, Wroclaw Medical University. Between 2002 and 2012 Dr. Yadach worked in the Department of Emergency Medicine University of Wroclaw, Department of Medicine Oral Mucosal and Periodontal Diseases University of Wroclaw, and Was a physician in the Department of Oral and Maxillofacial Surgery, Medical University of Wroclaw. He’s received complementary management training in implant soft tissues held in prestigious centers in the years 2005-2013: New York, Berlin, Stuttgart, and Genoa. In 2009 Dr. Yadach began training at the University of New York: Continuing Education Linhart Dental Program NYU Implant Continuum Education & OSIS & CEIA, which ended in August 2012 and has been certified at New York University. He is a lecturer and trainer on symposia and national and international conferences. In his own practice focuses mainly on microsurgery techniques and extensive soft tissue reconstructive surgery for the purpose of alveolar implantology. As one of the first doctors in Poland applied pre-orthodontic decortication procedure using piezoelectric device and first created a classification of anatomical indications for the treatment of maxillary sinus floor elevation with access from the hard palate. Dr. Yadach is also a co-founder of the Oral Surgery Academy.


www.yadach.pl 

www.dentalsalon.pl 


Howard:

This is a huge honor for me today to be podcast interviewing Radoslaw Jadach from Poland and I think you are, not only are you one of the most handsome dentist I've ever seen in my life, with your look, I love your foomanchew and your bold head, but the dentistry, the dental cases that you post are world class. You do dental cases that I've never seen anything like it. I'm going to read your bio, you graduated from the faculty of medicine and dentistry in Poland, department of emergency medicine, University of ... I can't say the name in Polish, forget, it's spelt W-R-O-C-L-A-W, I think it's Wrocklaw.

 

Radoslaw:

Wrocklaw.

 

Howard:

I won't even try that. I've lectured I your great country three times, and one of my very best friends is [inaudible 00:01:04], do you know [inaudible 00:01:05]?

 

Radoslaw:

Yes.

 

Howard:

You had training in soft tissue in the procedure centers in New York, Berlin, Stuttgart, Genoa in 2009. Began training at the University in New York, continued your education, line heart dental program, NYU implant, continuing education, OSIS and CEIA, certified at New York University. You are a lecturer and trainer on symposiums, national, international conferences. His own practice focuses mainly on micro surgery techniques and extensive soft tissue reconstructive surgery for the purpose Alveolar Implantology.

 

 

As one of the first doctors in Poland applied pre orthodontic decoration procedure using Piezo electric devices and first graded the classification of anatomical indications for the treatment of maxillary sinus for elevation with access to the hard palette. You have a private practice in Poland, The Dental Salon, and you're co-founder of The Oral Surgery Academy. I have to tell you, in all seriousness, I have seen dental cases for 30, 40 years and yours are just world class surgeries. The things you do, you literally look like Beethoven playing the piano, so thank you so much. I posted some of your YouTube videos on Dentaltown, I think I've posted three YouTube videos of yours, I hope some day you will create an online continue education course.

 

 

I think the 210,000 dentists on Dentaltown will love to see your work, it's amazing. People should follow you on Facebook, your Facebook page you're just always posting amazing cases. Thank you for joining me today, it's 9 o'clock in the morning in Phoenix, what time is it in Poland?

 

Radoslaw:

It's 5:00pm.

 

Howard:

5:00pm so you just finished your day.

 

Radoslaw:

No, no, no I'm between patients.

 

Howard:

I think it would be easier for you just to lecture because you have a friend of yours who is an interpreter. I think instead of me asking questions through the interpreter to you, to the interpreter to me. You have great talking points and I think you should just lecture, you're talking to probably, I don't know, 7 to 10,000 dentists right now, 80% of them are in the United States and 20% are in about 134 other countries. I think you should just take it away, just let it rip.

 

Radoslaw:

I'm with my friend because I want to feel safer with him. My English is not so fluently so from time to time I will ask him for help. Forgive me but maybe it will be a little disturbing our talking but I will feel safer with him.

 

Howard:

Well, it's amazing that you can speak English. They say if you speak two languages you're bilingual, if you speak one language you're an American. All my friends can only speak English unless they're Hispanic and they speak Spanish and English so I couldn't imagine trying to talk to you in Polish. All my listeners in America, they're amazed that you can speak English at all, congratulations on that.

 

Radoslaw:

Thank you.

 

Howard:

You talk about the three stages of knowledge. What do you mean by the three stages of knowledge?

 

Radoslaw:

Three stage, I taught my students that these three stages. First stage is, I know everything, it is first stage. Second stage is, I know nothing, I know that I know nothing and third stage is, today I know what I don't know. After study, after university, the young doctors are in first stage. They think that they know everything and I want to make shock in their heads that showing them that there is a lot to learn and there is a long way to be good in this job. After that they should feel that they know nothing, this second stage. Third stage is experience doctor should know what he doesn't know. What he should to learn more, more training, in which procedures he should be more work on it, because it's not so perfect and in my opinion there is three stages of knowledge.

 

Howard:

I want to ask you, when I think of you I think of amazing surgeries, amazing sinus lifts, amazing alveolar ridge buildup. When I talk to American dentists, half of them are afraid of surgery. They don't want to pull wisdom teeth, they don't want to place implants, and I always wonder why did you become a dentist? I mean, when you work on the human body, it's all surgery. Dentists, everything they do is with their hands, it's surgery. What would you tell someone who is listening to you right now, who's never placed an implant and says, "I just want to do fillings and crowns." When I look at Radoslaw Jadach YouTube videos, that's frightening, that's scary. How did you enter into surgery, why do you like surgery? Why does it not scare you or bother you when you're playing with someone's sinus?

 

Radoslaw:

Maybe because, I might think that from adrenalin and I need adrenalin for my life and it's a big pleasure to help people too, but I think it's too much for me be like a cardiosurgery or neurosurgery, when a patient can die. I want to have a lot of time to prepare to the surgery, to prepare myself, to prepare the patient, it may be consultation with other friend, with people experienced than me. Then when I've got a lot of information, whole knowledge about this case I can start the surgery.

 

 

I was working in a hospital for adrenalin, for more knowledge and now I know that hospital is not for me. I like very much that time of my life, worked 12 years in hospital on the [inaudible 00:08:42] department, in the emergency. I know how to use basic life support techniques, advanced life support technique. Today I'm [inaudible 00:08:58] for my employers, for my doctors and I don't lose my mind when it is something dangerous, if it happens with my patients I know what I have to do. I'm not panic because I saw lot of dangerous situation in hospital and emergency. Today I'm very easy and quiet when something is going wrong in my dental office and I know, "How can I help?" That's why I worked in a hospital and emergency [inaudible 00:09:47]?

 

Speaker 1:

It was like having a remedy against stress.

 

Radoslaw:

When I'm doing surgery, I can't thinking about something else. My mind is clear and I'm thinking only about this case, about this patient. My life problem, my problems with banks, problem with friends, with families, problems, disappear. No problem when I'm doing surgery, I feel peace and quiet like after alcohol.

 

Howard:

You're Polish so that would be Vodka, right?

 

Radoslaw:

Yes.

 

Howard:

Hey, I want you to talk about Sinus lifts, your sinus lift cases that you do are amazing. I'm 53 and I've seen different sinus techniques emerge over the last three decades. What is the state of a sinus lift today? There is many different ways to do a sinus lift. I know you like piezo electric devices, will you tell us about piezo electric and sinus lifts or just how you like to do sinus lifts?

 

Radoslaw:

I'm used to use the piezo electric, but I think if I use the diamond drills or piezo electric or SLA kit, special drill for approach to the sinus, it's not important what I'm using to make the osteotome window. In my opinion, we forgot what we are doing during surgery. We should operate ... [inaudible 00:12:02]?

 

Howard:

According to.

 

Radoslaw:

... according to anatomy and physiological tissues which we're cutting. In my opinion it's more important than stuff, it's technique, stuff doesn't mean technique. I can open window by knife it's no problem but the problem is how I prepare the flat, how I cut the periosteum, how I prepare my patient by pharmacology. Why head should be higher than foot, how it make my surgery [inaudible 00:12:49] without blood, because when there is blood I can't see what I am doing. The surgery should be clean and less traumatic than I can do.

 

 

From the other hand, if I speak with my friend, from time to time I see that they don't know what Schniderian Membrane is. It's not mucosa only and not periosteum only, there is the specific Schniderian Membrane very specific and they don't know exactly anatomy of this place and like Professor [Alfaraha 00:13:41] said on the last [inaudible 00:13:45] symposium in Poland. His alter of beautiful anatomical atlas for implantology that, when you're doing sinus lift without CB CT scans it is big mistake but when we do the CB CT scans, it doesn't mean that we know everything about the sinus. We should cooperate with Laryngologist, prepare the sinus before surgery. We should know what we have to do when the complication is during surgery. We should thinking what we want to do when we will be on the dental unit.

 

 

I'm trying to think like patient so patient want to do everything in one stage if possible. If I kill the Schniderian membrane, so I have to think, I have to learn how to finish the sinus lift in one stage ... [inaudible 00:15:06]?

 

Howard:

Despite.

 

Radoslaw:

... despite I kill the Schniderian membrane. We know two ways, one way I kill the Schniderian membrane and make collagen membrane and finish sinus lift or close the sinus, wait few months and waiting to regrow the new mucosa into sinus and start again the sinus lift. When I bought the volumetric tomography into my clinic and I see more anatomic structures so that's why I create the anatomical classification for best approach for some anatomic situations. When we should thinking about axial approach, when we should thinking about parietal approach or crestal approach. I send the article with professor [inaudible 00:16:28] to the journal of restorative and periodontal dentistry and we're waiting for activation of this article and I think it will be very interesting for our listeners and friends.

 

Howard:

Is there any way we could get that as an online course on Dentaltown, where you could actually show PowerPoint or videos?

 

Radoslaw:

Yes.

 

Howard:

I think it would be the most broadly watched platform because there is 210,000 dentists on Dentaltown, 40,000 downloaded the Dentaltown app on their smartphone and they can watch those online CE courses on their Android phone, on their iPhone. I think that you are the master of these sinus lifts and that would be a mind blowing presentation.

 

Radoslaw:

I'm ready to do it.

 

Howard:

You just made my day, you made my day. Can you go into more detail about sinus lifts? What type of bone are you using when you do a sinus lift.

 

Radoslaw:

Usually is a xenograft bovine bone.

 

Howard:

Bovine bone?

 

Radoslaw:

Bovine bone, yes. From time to time when I see that the cortical plate, there is only cortical plate. There is no strongest bone so I can't think that there is no enough osteoblast to create new bone so we have got two way, one way is waiting ... I put only xenograft and wait one year before implantation or I mix the xenograft with autogenous spongius bone taken from chin or retromolar area.

 

 

I haven't got experience with allo-graft, in Poland it's something new. We import the allo bone from Austria bone bank and we are [inaudible 00:19:02]. I think the next interesting thing is that if we've got only cortical plate, there is one big sinus and around these only cortical plate, it doesn't mean we can't do the implantation simultaneously. We can do this. I can show you the two ways, how we can do sinus lift and implantation, it not depends on the system of implant.

 

 

We can't put implant in the same time only whether it's the only half mini metal plate of cortical plate and we can put implant there. Like maybe you know but I'm not showing all of my cases on the Facebook or the other internet way because I want to show something more on the courses. Maybe on the Dentaltown when we will be webinar about sinus lift I can show this.

 

Howard:

I would love to see that. I've also noticed in the last third, I got out of school in 1987 and it seems like everybody wanted the implant to be the longest and now it looks like in 2016 that length doesn't matter as much as width and fat. Are you using shorter fatter implants, wider implants in the sinus region? Is that more of a trend that you see or are you still trying to get length?

 

Radoslaw:

Very good question. Now, there is a lot of factors when I'm taking to make the decision, how long implant I will use. If I can use shorter implant without sinus lift, I would choose that way because it's better for patients. It's more cheaper, less invasive and, in my opinion, it is better for my patients and faster. I will operate shorter so I can take two patients during two hours not one patient during two hours.

 

 

From time to time, there is other factors, for example prosthetic factors. If we've got the bone lesion, bone defect, crestal defect, when I have to create longer crowns, there is a horizontal defect so I have to ask my patient, "Do you want longer teeth?" Because in medicine we've got pluses and minuses.

 

Speaker 3:

Advantages and disadvantages.

 

Radoslaw:

Oh, advantages and disadvantages. From time to time men said, "Oh crown could be longer or not, it's not important for me I want to bite only," but women say, "No, no, no this crown should be same like on the other side, because my smile is so wider and I'm showing during smile my second molars. It should be perfect." I should do the GBR technique to create more crestal, not go to the sinus, so it's the other factor. Shorter implants are very, very useful in the mandibular because mental nerve and mandibular nerve. If I may put the shorter implant without complex surgery, complex GBR to the [inaudible 00:23:46], I would choose shorter implant because it's better for my patient and less invasive, but it is dangerous for long term results.

 

 

For example I see that, okay, between top of the crest and mandibular canal I got 16 millimeters only but 3 millimeters of it is only cortical plate, so the short implant will not work because this cortical bone will not grow into the surface of the implant. It will be taken only by 2 millimeters in spongius bone. It is very important to do this CB CT scan and slices and examination of that bone when we will put the implant. From time to time I have to decorticate this crest and create new bone spongius bone in that [inaudible 00:25:02] then put the short implant.

 

 

It's not easy to say short implant are always better than longer implant, no, but I'm against putting the 15, 16 millimeters implant into the sinus because it's not so important. If we put into the sinus more xenograft there is more possibility to contamination by non anoxygenic bacteria because the blood will not go to tension of this graft.

 

 

If I've got graft like this in sinus, and like this, here will be wet and no blood, in blood antibiotics and other cells factors which gives us regeneration, give us the safety against bacteria and there will be center of starting the inflammation. We should put enough xenograft for implant like 10 or 11 millimeters, it's enough, maybe it's enough and when we elevate the Schniderian Membrane we should remember about complex of [hiatus macularis 00:26:57] connection between nose and sinus, it should be open. The sinus should be connected very well with nose because if it's not connected when the edema of the mucosa inside, we can expect the inflammation after sinus lift procedures.

 

 

When we do only sextant CB CT scan little hole is not enough to say, "Okay I can do the sinus lift here." We should make more and healthy side on the second side to compare why that sinus is in good condition and that one is in wrong condition, bad condition why? In my opinion a lot of complications during sinus lift is because our patients were bad diagnosis before surgery.

 

 

Today I got, I don't remember when I got problem with sinus after sinus lift procedure but I remember that it's because my friend Dr. [inaudible 00:28:34] from Poland and he told me that the sinus should be very well connected with nose. Make more CB CT scans to see the structure, we call it in anatomical hiatus macularis, it should be open very well. If the teeth should be healthy nearby the sinus, should be healthy, so there is a lot of factors we should know and examine then before surgery and after that, we can make safe surgery for our patients, money is not correct way to ... Money is on the second or fifth place.

 

 

First place is the safety of our patients, if they are safe, if they are happy, we will be happy too.

 

Howard:

A lot of people like yourself who are taking CB CT's and doing sinus lifts, a lot of people are noticing that a lot of patients have failing root canals that have been failing for a long time and the sinuses are infected and nobody ever knew it. The dentist didn't know it, the patient didn't know it, do you see a lot of chronic failing maxillary root canals that have infected the sinus and the patient might think they've had sinus problems or allergies or other things when in fact it's really a root canal that's been chronically failing for a long time and no one was aware of it? Do you ever see that?

 

Radoslaw:

Yes a lot of, during cooperation with the laryngologist from my town and from Poland, from my country, they are treating the sinuses, frontal sinus, ethmoidal sinuses, maxillary sinuses and it's treated, treated, treated again, treated, treated, treated and there is still inflammation, still inflammation. After two years of treatment they're asking themselves why? After two years, why, maybe it's the teeth.

 

 

Send these patients to the dentist and what dentist should do, dentist should do ... I'm dentist but I'm prosthetic. Go to the dental surgeon they know more than me, no the prosthetics will make the OPG only and right, everything is correct with this but it's not good way. From the other inflammatory in sinuses because this is one problem of course but the other problem is that in general problem with kidneys, before transplantation of kidneys, before transplantation of bone marrow because leukemia for example. We should do always CB CT scans, not OPG only to see if there are any little inflammation because of tooth.

 

 

If yes, we should remove it, not treat it, remove it because we can replace the teeth but we can't replace the heart, lungs kidneys and [inaudible 00:32:31]. In my opinion it is a big mistake when we write to the transplantologist, everything with teeth is okay, I see this only on OPG. OPG is not enough.

 

Howard:

What is OPG?

 

Radoslaw:

It's a panoramic X-ray.

 

Howard:

Okay a pano.

 

Radoslaw:

What else, after old canal treatment with Endomethasone for example. I can see a lot of [Aspergillus 00:33:12] in sinuses, it's a form of the fungi, fungus inflammation. If there is a fungus with Aspergillosis, we should think about very radical cleaning of the sinus. It is a [inaudible 00:33:39] procedure should be done because of Aspergillus and if patient has got [inaudible 00:33:50] two years ago, and come to our dental office and wants implant and sinus lift we should ask him if there was any surgery in sinuses, yes or no.

 

 

If yes, what kind of, it was [inaudible 00:34:11] we can expect some problems with scar tissues inside which is very difficult to disconnect with bone, so for example close technique is not recommended then. Close technique after surgery in sinus is not recommended in my opinion, we should open like Professor Stephen Wallace from New York said, as you get problem you've got in sinus you should open wider to see what is there, not by little window.

 

 

I can talk about sinuses few days if you want.

 

Howard:

Keep going I love it, just keep going I love it. You also said GBR twice and a lot of listeners might not know what GBR means. Can you explain GBR?

 

Radoslaw:

It is guided bone regeneration, GBR guided bone generation, so we can say about GBR when we use the collagen membrane. GBR means that where the bone is growing one millimeter per month but soft tissue grows one millimeter per day. It's faster than bone, so we should disconnect this tissue from the bone because soft tissue will grow into the bone defect faster than new bone. That's why we call it guided bone generation, we guide that the soft tissue should heal alone and bone should heal alone. This is GBR, but GBR doesn't mean augmentation.

 

 

Augmentation is the other procedure, so for example we've got the cyst inside the bone. If we do the Cystectomy and remove it and send it to the histopathological examination we can do two things, first we can refill this bone defect by xenograft, autograft, no problem but we can fill it, so with really do only fill it by some graft, it is augmentation. It's increase of the volume it is augmentation. Augmentation means I increase the volume of soft tissue, volume of bone no problem but I cannot not put the xenograft out of that allo-graft.

 

 

I can leave it empty but on the osteotomic window to the cyst, it was my approach to remove the cyst osteotomic window. I can close by collagen membrane, so soft tissue will not grow into the bone so there will be empty space which will be healing by bone. This is guided bone regeneration without augmentation. It is explanation in my way.

 

Howard:

I want you to weigh in on something very controversial in the United States, some dentist will not place an implant or a sinus lift on a smoker. Other implantologist will, will you talk about smoking, if a patient comes in and they smoke a pack a day, do you refuse treatment or do you ... What are your thoughts on a patient who is a pack a day smoker, 20 cigarettes a day?

 

Radoslaw:

I'm doing sinus lifts to the patient which are smokers, it's no problem for me, bigger problem is alcoholic patients.

 

Howard:

Really?

 

Radoslaw:

Really why, because the smoke between my graft and smoke is Schniderian membrane and collagen membrane, so they will never, never meet each other. Okay, I know that smoke is big factor for oncology problem, okay I agree, the smoke is not only nicotine but 40 other whole table of Mendeleev. Smoke will do [inaudible 00:39:28] of the Schniderian membrane and from time to time where the Schniderian membrane is [inaudible 00:39:35], we can expect that the healing of the wound will be slower in smoker person than non smoking person but this is one problem only in my opinion.

 

 

Why alcoholic patients in my opinion are more dangerous for our result, because alcohol is in blood so this alcohol penetrate my graft. I know that my graft will be stabilized by blood clot, blood clot will change into the fibrin, fibers of the fibrin, they will create an osteoblast is a moving cell, and this osteoblast should be moving on this fibrin. If we know it, that alcohol paralyses the ability to movement of the osteoblast so I can expect that in alcoholic patients there can be no bones or the bone will be very, very poor.

 

 

I've got one patient with Von Willebrand disease, if you know what is it, Von Willebrand disease, it's lack of H factor in blood, and I've got three times implantation in sinus in the patient and three failures, there was big problem and I'm starting reading about Von Willebrand disease and there is a problem with fibrin. They will not create fibrin, they will not create blood clot. We put the H factor into the vein and we've got two hours to do some surgery safe, but the fibrin is created after the two hours and osteoblast grow into after these two hours. Now today I know that maybe interesting but it's not in literature, we've got the patient with Von Willebrand disease we should be very, very careful with sinus lifts or GBR procedures.

 

 

Becasue in this patient I put four implants in all the places but into the natural bone, we put enough bone and I put the implant and every implant is working well, are working well but that one in fifth molar when was the sinus lift procedure disappeared. I got only once case like that, so I can do the 100 patients like that one because it's very rare disease, Von Willebrand disease is very rare, so I can improve that. I want to speak with somebody who maybe knows more about Von Willebrand disease and maybe with orthopedic surgeon, maybe they know something more about this. This very, very interesting topic and today this patient is my friend and we talk a lot about this so smokers in my opinion is not problem. I can say about one patient, we have planted two sinuses in one time and I told him, okay we've finished right sinus now we will prepare to do the left sinus and, "Okay, one minute break, I have to go to the toilet."

 

 

It was December 50 degrees under zero, and I'm waiting for him and I'm looking through the window, and he in front of my window and smoking. Everything is working well, five years till today, but what can I say, I see that patients who smoke THC drug.

 

Howard:

Marijuana?

 

Radoslaw:

Yes marijuana they heal very well, very well with no problem. This is medicament too.

 

Howard:

You're having the most problem with not marijuana or cigarettes but actually alcohol, alcoholics?

 

Radoslaw:

Yes.

 

Howard:

I'd like to remind everybody, you know who my first sinus lift, who I did my first sinus lift on? My mother-in-law, isn't that what mother-in-laws are for, she was so sweet she didn't care.

 

Radoslaw:

You are very great.

 

Howard:

I want to ask you another question we get a lot. If you go to Cologne Germany, the big IDF meeting, there is 275 different implant companies. In your mind are they all the same or their difference is titanium, titanium, titanium or do you like certain implant systems better than others? Because how does an individual pick between 275 different systems?

 

Radoslaw:

Very good question Howard. In my opinion I can say like professor Weber from Germany, this system is very good, which worked very good in your hand. It's the first rule. Second rule, it's not matter what kind of implant I will put into the bone, I can put deep into the bone, but patient come to my dental office, not for implant but for crowns, for teeth, so if I will choose the implant system I will not looking for the surgery guide but show me your catalog of prosthetic solutions. If I can use CAT Cams, individual solutions, individual healing, individual abutments, bridges, show me what I can do in prosthetic on this system.

 

 

Third sector is, the service of the company which will care about me and my patient. For example, I don't want to say what company supports me but I got 11 companies of implant in my dental clinic, 11. Because from time to time this company has got problem with import, this company has got problem with stock so it doesn't mean I have to stop implantation because they have got problem with stock so I always have got plan B, C, D. Because will not wait for me and he goes to my competition, to the other dental officers.

 

 

Today I can say that I can say about some companies that they are the best, there is not the best company I'll choose the company which are two kilometers from my dental clinic and when in Sunday everything is closed and patients from England come to my office and say, "Okay doctor, I'm here only two days, do something today," and there will be 16 implants and this huge money in future work. I see into my magazine I got only 10 implants, I need 6 more, so I make phone to my company and they open for me the stock, put into the taxi, this taxi, bring it to me after 20 minutes. This company is very good for me and today I can put all implants into the bone with good success, but the third factor is how tight the elements will fit.

 

 

Because we know that crown solutions or like in [inaudible 00:50:19] there is no cone but is very tight, there is less space than bacteria is, so this is important for me but Professor Marcos [inaudible 00:50:34] said, "I got no any problem, no problem with bone resorption around the platform, why? Because I'm always put the implant, platform implant super crestal and create more soft tissue, so bone is safe because the platform is higher than crest." If I know that, it's not important for me what kind of implant I will use.

 

Howard:

How do you attract patients from England to fly to Poland, do you market dental tourism or is it lower cost because of the difference in currency between the Polish money and the British pound is this just word of mouth referral. Are you advertising around Europe trying to get dental tourism, is it people who just want to visit Poland, talk about that.

 

Radoslaw:

I make zero advertising, zero, by the word from mouth to mouth. A lot of people from UK, it's Polish people which live there, but if they are happy after my surgery, they told about it for England friends. "I will show you my town and you will make your new teeth, they've got the drill machines, milling machines and they can do everything three days only and full smile no problem."

 

 

I can see that in Poland, we have got few doctors and very, very good, you know them on the Facebook. In Poland out dental clinics are very well equipped very well, we've got tomography, milling machines, we've got everything like on the whole world. Our government has very high expectations for us and make the acts of law with high expectations for Polish doctors. We can say that our treatment is on the high level, so maybe it is interesting for patients too but the price is on the second place but I can see something interesting, I might do implantation for 3000 Zloty, one dollar is 4 Zloty.

 

 

I put the implant for my patient, the price is 3000 Zloty, it's less than $1000 but I buy the implant, when I buy the implant the price for me is $250. It's quite more than you, so my price for implant is less but my cost are higher than other countries and in my opinion it is very, very strange why.

 

Howard:

Why don't you buy them from other countries?

 

Radoslaw:

Because the companies block, they send me, we've got our distributor in your country so why do you want to buy from us, we can do this, because we will kill our distributor in your country if you will buy from us. This is the problem, but it's not difficult problem, okay, I will put more implant and no problem. I'm a little overworked with my friend so this is the problem.

 

Howard:

I want to ask you another controversial question, some people who do sinus lifts think that you need to draw blood and spin blood and platelets and what have you and other people say that's not necessary at all. Do you draw patient's blood and spin the blood when you're mixing your bone grafting materials or do you not find that necessary?

 

Radoslaw:

It's not necessary in my opinion. We can see here about APRF, PRF, and other techniques okay, and read about it, I'm very carefully read what happened on the world about this technique, but what can I say? Why they have got same results like me without PRF, I got same result or better but it's not necessary to create higher stress for my patient to take the needle, put into the veins and grab the 40000 millimeters from the vein, why for what? If I will feel like patient I will afraid why dentist put something in my veins and take my blood why? He's only dentist, so it is not ...

 

Speaker 1:

It doesn't give the expected results.

 

Radoslaw:

In my opinion the future is stem cells, this is the future, and I have got few cases like that. I take the stem cells from iliac crest and I can mix it and stem cells are living two hours and a half outside the organism, it is something wow, it's perfect. The stem cells can become a tissue ...

 

Speaker 1:

With another tissue adjacent to it.

 

Radoslaw:

This is something beautiful like chameleon, I stay nearby the bone, I will be the bone. I stay nearby the gum, I will be the gums so the stem cells, it is the future, APRF, PRF, okay it's very interesting but in my opinion the more important thing is how do you operate, if you catch the soft tissue by [inaudible 00:58:50] and push it, it can't heal very well. You should take it very gently, should be very gentle, your acid should be very gently.

 

 

Your section tip, you have to have two section tips, one suction so before saliva, and only for saliva and other tip only for blood into the wound. You can't mix it, because bacteria will contaminate the wound but nobody cares. When they ask me, why you have got so little inflammation? Because I know the pharmacology aseptic rules, everything and if I do everything correct with these rules, it should correct healing. If young doctors ask me, "Okay I want to study PRF?" I don't recommend it, but maybe I have not experience with it, okay but I don't recommend it why? Because I've got same results, or better than people who use the PRF. Maybe it's very controversial words but I think like that.

 

Howard:

We are out of time, I can't believe that was the fastest hour I've ever done a podcast I think you are amazing. I am so hoping that you will create a continue education course on Dentaltown. I think thousands of people will watch around the world. I got to ask you a foolish trivia question, do you know what city around the world outside of Poland has the most Polish people outside of Poland?

 

Radoslaw:

Los Angeles.

 

Howard:

No.

 

Radoslaw:

I don't know.

 

Howard:

It's Chicago.

 

Radoslaw:

Really?

 

Howard:

Chicago has one million Polish people and there are parts of Chicago where you think you are in Poland. I've been to Poland three times, and there are areas of Chicago where all the signs are Polish, all the people are Polish and there is over one million Polish, if you want to eat the bet Polish food in the world outside of Poland, you have to go to Chicago. It is truly amazing but I just want to say that I thought the Chopin museum in Warsaw was one of the most amazing. I was like Chopin more than Beethoven or anybody else. I love your country, I love your people. I love [inaudible 01:02:03], will you tell him I said halo?

 

Radoslaw:

Yes.

 

Howard:

Tell him that he should do a podcast on Chirodontics, where he is mix Chiropractic care with dentistry. I think he's an amazing man too, but thank you so much for spending an hour with me, I really appreciate it, I think your work is world class. I've seen cases that you've done that I don't think anybody compares to it, so thank you for all that you've done for dentistry and we really look forward to a course from you on Dentaltown that would be world class.

 

Radoslaw:

Thank you Howard, thank you listeners and people there, it was great, great honor for me to be with you and I really appreciate your invitation and it's very important for me. Thank you Howard.

 

Howard:

Have a great day and I hope to have a drink with you in Warsaw some day, in Poland some day.

 

Radoslaw:

I will prepare the great vodka for you.

 

Howard:

Okay thank you.

 

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