Dentistry Uncensored with Howard Farran
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380 Implants, Perio, and Aesthetics with Howard Gluckman : Dentistry Uncensored with Howard Farran

380 Implants, Perio, and Aesthetics with Howard Gluckman : Dentistry Uncensored with Howard Farran

4/30/2016 9:51:45 AM   |   Comments: 0   |   Views: 452

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AUDIO - DUwHF #380 - Howard Gluckman


Dr Gluckman completed his dental training at the university of Witwatersrand in Johannesburg in 1990. After spending a number of years in a general practice he completed a 4-year full time degree in Oral Medicine and Periodontics at the University of Stellenbosch in Cape Town, which he completed with distinction (cum Laude) in 1998. He was intimately involved in the development of the postgraduate diploma in Implantology at both the University of Stellenbosch and later at the University of Western Cape. He is currently in full time private practice in Cape Town He is the director of the Implant and Aesthetic Academy, which is a private post graduate training facility in South Africa currently providing a complete postgraduate training program in Implantology in South Africa. The Academy is accredited accredited by The University of Frankfurt. He has been involved in Implantology training for 18 years.

Dr Gluckman was the author of a monthly Implantology corner for the South African Dental Journal and is the immediate past president of the South African Society for dental Implantology and on the board of the Southern African Association of Osseointegration (SAAO). He has served as the secretary of the South African society of Periodontics. He has lectured extensively nationally and internationally and is a member of Dentsply/Friadent's Master Speakers Program.

His special interests are immediate placement/immediate load as well as soft tissue aesthetics and periodontal plastic surgery. Autogenous bone augmentation especially bone harvested from the palate and three-dimensional bone augmentation.

www.ImplantAcademy.co.za 

Howie F.:

It is just a huge honor to be podcasting here with the most famous Howie in dentistry, Howie Gluckman. Sorry I don't have a voice. First we're going to have a big shout out to ...

 

Howie G.:

Ken Serota , who actually made this whole thing possible, because he is damn fine.

 

Howie F.:

Ken is an amazing man, and that's what I love about the internet. I met Ken on [Root ZX 00:28] I think in 1998, and now with the internet and Dentaltown and Facebook, and he was with Roots and Generation Next, and all those websites, I feel like you're a brother. I have to tell you, Howie, when I was leaving and whenever I saw [inaudible 00:47], and they'd say, "Where do you lecture next?" I'd say South Africa, a hundred percent said, "That's where Howie Gluckman lives." I told Ryan, I said, "We are not leaving South Africa until we podcast an interview with the Man."

 

Howie G.:

I have to tell you, that's the most amazing thing, because that's what the internet has done, is it's brought people from the most diverse and weirdest places, and they've kind of brought them into the fore, where you probably would never have heard of them or seen of them before, ever. As much as I post stuff on Facebook a lot and that's where Ken and I got to know each other, I mean, we post only the greatest stuff, we don't post any of our bullshit that comes out of the bottom drawer. We only post the best stuff, but it's amazing, because it's kind of brought all these small countries and little places, and I mean, you know, guys like, I mean, here from South Africa. Who would ever know?

 

Howie F.:

Well, I have to tell you, I know you're a very humble guy, I think most Howies are.

 

Howie G.:

Present company excluded.

 

Howie F.:

When I ask a lot of my friends in Phoenix before I was leaving, I said, "Well, what do you, how would you summarize Howie Gluckman?" They all said they thought you were the greatest implantologist and periodontist they'd ever seen. I mean, that's what they say, that's what my friends in Phoenix say. I kid you not.

 

Howie G.:

Well, you know what I said to you. That's bullshit, for one reason only, is that there are so many great people out there. There are so many phenomenal surgeons, phenomenal prostho guys, that no one can ever be the best at anything, because there's always one person that's always going to be better at one little thing or one item. It's just the most amazing thing about the internet is that we learn so much from so many diverse people, from Russia, from Greece, from places would never have expected before that you would think, wow, these guys know nothing. They know so much stuff. It's amazing.

 

Howie F.:

Well, Russian cosmetic cases look better because they soak them in vodka before they take the pictures. So they just look so nice. Hey, a lot of, 83 percent of the fans of this show are from America, so a lot of them don't know initials from other countries. Howie Gluckman, it's BDS, then it's MChD OMP. Explain what those initials mean, and explain what all that's about. Because they just know in America, DDS, DMD.

 

Howie G.:

Well, I think in South Africa, we have a fairly unusual way of doing our specialist degree. I'm a specialist in both oral medicine and periodontics, and that's what OMP stands for, oral medicine periodontics. We have a, we do a BDS, which is a Bachelor of Dental Science, which is an undergraduate degree. Then after that, you are then able to do, once you've done a certain amount of years as a general dentist, you can then specialize. The specialist degrees are four-year, full-time specialist degree, which I think is a little different to most countries, where they do a two-year postgrad or two, maybe three maximum.

 

 

In South Africa, it's a four-year, postgraduate degree, full-time, so we are full-time at a hospital. In South Africa, we have, both oral medicine and perio is one subject, as well as implantology, and so we become a specialist in both oral medicine and periodontics and implantology.

 

Howie F.:

What does the MChD stand for?

 

Howie G.:

It's a Master of Dentistry, it's like a Master's degree.

 

Howie F.:

I understand the M is Master's and D is Dentistry, but what would "Ch" be? It's capital C, small h.

 

Howie G.:

I haven't worked it out yet. When you do, tell me.

 

Howie F.:

I think a lot of, maybe it's just me, but when I see BDS, does that usually mean the country used to be part of the British colony?

 

Howie G.:

Yes, well, South Africa is a British, is one of the colonies, and obviously, we are part of the Commonwealth, as much as Canada and New Zealand, Australia, etc., etc., India, all those countries are Commonwealth countries. South Africa is a Commonwealth country. Although I think as far as our BDS goes, I mean, it's pretty, I don't think it's as much similar to the U.K., and certainly our Master's degree is nothing near what the U.K. does. Ours is a much more extensive degree than the U.K. run, where they have a two-year postgrad program. Ours is a lot more extensive than that.

 

Howie F.:

It's kind of funny because this was a British colony, but South Africa has a long, extensive history. I mean, the Portuguese came here, the Dutch came here, the British came here.

 

Howie G.:

The Portuguese were more a little bit north, they were more in Angola and Mozambique. South Africa, for those who don't know, South Africa is very much a, we were first discovered by the Dutch, okay? Vasco da Gama and things like that.

 

Howie F.:

Vasco da Gama was Dutch?

 

Howie G.:

As far back as the 1600s, the Dutch East India Company, they came round and they discovered the Cape. I come from Cape Town, which is obviously that whole area is Dutch. Then we have a language in South Africa, which is Afrikaans, which is very much a mixture of Dutch German, so if we go to Holland, we can really understand a little of what they're saying. We are really, we are basically Dutch, French, and German based.

 

Howie F.:

Really?

 

Howie G.:

Yeah, which is quite unusual. Then the English came, as the English would normally do, and they would then take over anything, as the English did in those days.

 

Howie F.:

Well, the English don't take over anything. Their rule is if they put a flag up, it's their country. It doesn't matter if there's a billion Indians living in India. If they put a flag there, dammit, it's theirs. Basically going to, I went to the museums, I went to the apartheid museum. It sounds like, in San Francisco, they found gold in 1849, and that's kind of what got a lot of people out there. Alaska found gold, there was a lot of people. But it sounds like about 1860s, they found gold here, and that's when the whole thing exploded.

 

Howie G.:

Well, it wasn't just gold, it was also diamonds. I mean, if you think about diamonds, South Africa is probably the biggest diamond-producing country in the world, next to Russia. Still a South African company, DeBeers, DeBeers is an international company but started off in South Africa, which was started by some of the early English settlers. I think Barney Barnato was one of them, I stand corrected on my history, because I might be wrong on that regard. DeBeers still pretty much control most of the diamonds. So diamonds was huge. Gold definitely was a massive thing, because gold was a currency and still remains a currency today, more so than diamonds. Both diamonds and gold, we are very, very strong in, and still remain so today.

 

Howie F.:

You said Russia finds more diamonds than South Africa, but DeBeers ...

 

Howie G.:

I don't know about whether they find more diamonds, but Russia is a massive diamond producer, as well as South Africa, but it is controlled by DeBeers. All the diamonds in the world are controlled by DeBeers, which was or is a South African company.

 

Howie F.:

I rank up there high, because I bought diamonds for two ex-wives, so I'm really high up there.

 

Howie G.:

That's a very small amount.

 

Howie F.:

I might be the fifth person behind ...

 

Howie G.:

You know the craziest thing is that diamonds are a very, if you think about how many diamonds are found, there are so many diamonds in the world, but DeBeers actually holds back massive amounts. They have got, you cannot believe how many diamonds they have, which they hold back to make sure that the diamond price stays high, because they control every single diamond from around the world.

 

Howie F.:

How long have you been doing, do you consider, okay, I want to get this. You're known around the world for periodontics and implantology. Would you say that's ...

 

Howie G.:

Pretty much, yeah.

 

Howie F.:

Pretty much. Let's get right to the chase. A lot of dentists ...

 

Howie G.:

On Facebook.

 

Howie F.:

Well, Facebook, we love Facebook because Mark Zuckerberg's dad is a dentist.

 

Howie G.:

Absolutely, really?

 

Howie F.:

Ed Zuckerberg, yeah.

 

Howie G.:

I didn't know that.

 

Howie F.:

Well, then you're not listening to my podcasts, I did a podcast with him.

 

Howie G.:

Wow, amazing.

 

Howie F.:

His name is Ed Zuckerberg, he's an amazing man. Yeah, I've had dinner with him, he's a great guy. He did a podcast on how to build your practice with Facebook. It's a great podcast. He's written many articles for Dentaltown magazine. Yeah, so Mark Zuckerberg is married to, he's a dentist, his wife Karen is a psychiatrist, they had four kids, a boy and three girls, and the boy is Mark Zuckerberg of Facebook. So yeah, Facebook is amazing, and by the way, what a family. I don't know what, whatever you hear about Mark Zuckerberg, Ed Zuckerberg, but it's just an amazing family, quality family, great guy.

 

 

Anyway, so let me just, I'm going to ask you a very long question, and you can decide how you want to get an answer. Some people say when they look at these implant studies that these implant companies are cherry-picking the studies. They're doing only implants in the mandibular anterior, they're doing it on patients who maybe lost a tooth from trauma or decay. Then they're saying their implants have a 95 percent success rate.

 

 

Then other people are saying that in the real world, that more teeth are lost from periodontal disease, and that when you start placing implants, and they got periodontal disease and peri-implantitis, some people are saying that as high as maybe a 16 or 20 percent failure rate. Is there a difference in success rate? So my question is this. Is there a difference in success rate if I replace an implant in a tooth that you knocked out from trauma, versus a tooth that you lost from periodontal disease?

 

Howie G.:

Listen, there's no debate, there's not even a debate. The minute you have perio disease, you have a much, you've got a lot more problems to associate, because peri-implantitis, peri-mucositis, is closely associated with periodontitis. Diabetes, periodontitis, all those factors are going to impact on your success rates. We know that there's lots of data, lots of good scientific data that shows us, that if you have periodontitis, if you have diabetes, if you have certain other medical history disease, you are going to have a poorer prognosis.

 

 

You can't kind of lump everything together and say, if you have, everybody is the same, because everybody is not the same. By the same token, one talk about how companies will manipulate studies and stuff like that. There's no debate that, I think, I'm sure you've watched the movie, "The Constant Gardener," which is all about the pharmaceutical industry and how the pharmaceutical industry really manipulates their studies to show their medical stuff is good, and they buy other stuff, and they shut it down, even though it's working better than their drug.

 

 

I think the same thing happens in dentistry, whereby you know, companies will say, "Right, we'll give you all the money that you want to do, to do the study, but when you do the study, we will decide whether you publish it or not. If you have a positive result, great, we'll publish it. If you have a negative result, sorry, we're not publishing the data." I think that really, you know, it kind of, money talks, and money talks. It's a bit of a sick system, really, because I think it happens too often. I think we see it far too often and you see it a lot on Facebook, where guys are doing certain techniques, where certain guys are being paid a lot of money to say, "Hey, wow, look how fantastic this technique is, it works brilliantly." They show five good cases, when they've got twenty others that were a disaster and didn't work.

 

 

That's actually a bit of a bugbear of mine, that actually pisses me off quite a bit. A lot of people claim, they make claims of stuff that "look how wonderful it is," when in actual fact, it doesn't work for the normal guy. The normal guy turns around and he says, "Well, I've done everything that you've told me to do, but it's not working for me. What's the problem?" The problem is that there's no predictability with the techniques that these companies and doctors who work and are paid for by these companies are talking about.

 

Howie F.:

Now are you talking about the United States government, or implant companies?

 

Howie G.:

I'm talking about implant companies.

 

Howie F.:

Because the entire United States government is bought and paid for. Here's another question. When I get feedback from these podcast people, most of them are pretty young. I would say 90 percent of all the e-mails I get at howard@dentaltown.com, they're thirty and under. I'd say 20 percent are still in school, and most of them are young. Podcast people are just young, they're commuting to work, they're on a treadmill, whatever. Help them out. They go to a dental convention, like the big ADA convention or clone, there's 175 implant companies. I try to help them out, that with dentaltown.com, no dentist will ever have to practice solo again. Help these people out. How do you pick an implant system, when there's 175 to pick from and [osteo site 13:00] doesn't know the difference between Nike and Reebok.

 

Howie G.:

I think there's no debate that every system works, as long as it's titanium and it's prepared in the right way, it's got the right surface texture, there's no doubt it works. You know, the way we, for our academy, the way we tell guys, we never prescribe a certain implant, you must use this or you must use that. Because I think it differs from person to person. Like say, you look at my technique. My technique is I want to extract, I want to place, I want to immediate load all the time. Another guy's technique might be, I want to extract, I want to leave for a month to heal, then I want to place the implant, then I'm going to leave ... There's a difference in the way our techniques develop as to how we place our implants.

 

 

For me, if I'm a guy that places, and I have, I want to do immediate placement, do immediate load, I need an aggressive thread, I need something that's going to give me high primary stability. Whereas a guy who's not doing that, it doesn't really matter what he uses. He can use really anything. It really boils down to your support. Is the company a reputable company (A)? (B) Have they been around for a while? (C) Are they going to be around for a long, long time, or is it some kind of guy that's making implants in his back garden and selling them as cheap as possible?

 

 

It's really about support. Can they support you? Is it something that's going to be around for a long time? Is it somebody that say, "All right, okay, I'm using an implant system, it's my own implant system and it works really well, and it kind of, you can use their systems from this and this and this system, all work on there." Fine, great, because then you know that you're going to have components that are going to be there.

 

 

I think you really have to be fair to your patients, you know, because your patients are going to hopefully have those implants for the next twenty to thirty to forty to fifty years. If they have that, are the, is the componentry going to be available to that patient for all those years?

 

Howie F.:

Okay, so this is a really bizarre question, really weird, but I can't think of anybody I'd rather ask than a periodontist implantologist like you. Some people are treatment planning an implant. It's an upper denture, and the person might have like lower four, five teeth, and they say, "You know what? I'm going to save two canines, and I'm going to place two implants in the bottom," or whatever. Okay, so they're going to save a couple natural teeth, and they're going to do some implants.

 

 

Other dentists are saying to them, "Dude, they've lost all their teeth from gum disease. Even though these pockets are three or four millimeters, the gums are bleeding, so the bugs are in there. It would be better if you pulled all the remaining teeth, and let it heal up for twenty-four hours, so there's no anaerobic environment, all the teeth are gone." So that's all the p. gingivalis be gone, and then if I go in a week later and place two implants or four for an over-denture or whatever, they would not get peri-implantitis, because you got rid of all the p. gingivalis because there cannot be p. gingivalis unless there's an anaerobic environment. A tooth has got to be sticking out somewhere, and a fully [inaudible 15:53] person would get rid of all the p. gingivalis. Then I don't have to worry about ...

 

Howie G.:

That's not true.

 

Howie F.:

By the way, you mentioned the term, so I got to go back and clarify. You said peri-implantitis and peri-mucositis. Some one might not understand the difference.

 

Howie G.:

Peri-mucositis is where you just have an inflammation of the soft tissue, with no destruction of the bone, whereas peri-implantitis is where you have an infection of the soft tissue as well as destruction of the bone. That's more advanced. It's like gingivitis and periodontitis. Peri-mucositis, peri-implantitis, it's the same correlation. Okay, let's go back, because it's a great question. The first thing ...

 

Howie F.:

You're the first person ever said that.

 

Howie G.:

What?

 

Howie F.:

That I had a great question. Just kidding.

 

Howie G.:

It's because I'm South African.

 

Howie F.:

You're just being polite.

 

Howie G.:

Exactly. Okay, the first thing is that there's no right or wrong answer here because, and anyone who says you have to go this way or have to go that way, in my opinion is an idiot. Because it all comes down to what your patient needs are, it's not got to do with what your knowledge is about. I always say, we have a fantastic saying in South Africa. "If all you have is a hammer, then everything looks like a nail."

 

 

Sometimes, if you look at a Bell curve, there are certain patients that fit on one side of the Bell curve, where they'll take everything out. Whatever you say, I'll take them out, I don't care, even if they're healthy, I don't care, even though I have no periodontitis, I'll take the teeth out. Then you have on the other side where the patient comes in with teeth flapping in the wind, periodontitis, and they say, "You're not taking my teeth out."

 

 

The fact is, we have to treat the patient, and what that patient's needs are will determine what the patient's treatment plan is going to be. If he says, "Listen, I actually don't want to take these teeth out, doc," you will do everything you can to save them and put implants to replace the rest. That's the right treatment plan for that patient. To try now and say, "Well, listen, I know better, and if there's no perio around those two teeth, why can't you put, why can't you leave them?" In fact it's better, because the fact of the matter is that if you've got two teeth that are still natural, that still have some kind of proprioception, there's no doubt that you're going to have a far better feedback mechanism to not overload what you've got. Whereas, once you lose all the teeth, all your proprioception goes.

 

 

That's the first thing. The second thing is that the whole concept of where your bacteria are, you still have, I can't even remember the name, but the a.a., what we used to call actinomycetem, the actinomycetemcomitans, I'm not going to remember the fist name, they live on the tonsils, they live on the everywhere. The p. gingivalis live all round the mouth, and not just in the sulcus. The fact of the matter is ...

 

Howie F.:

They're living on the tongue, too?

 

Howie G.:

They're living on the tongue.

 

Howie F.:

The tonsils, the adenoids.

 

Howie G.:

They're in all those areas. The fact of the matter is, if a person does not have pockets around those teeth, there is no justification to take those teeth out, just because you think that they're going to have ... How do you know, in fact, Roy Page many, many years ago, said that, I don't know how right or wrong he was, but he made a statement which is quite, for anyone that's been a periodontist for a long time will see, is that a lot of our patients really, they have perio that dies out. It just doesn't progress. It gets to a certain stage and it just stays [inaudible 18:52].

 

 

We always treat our, we always tell our students, if anyone ever says to you, show me an X-ray, when you see the X-ray, has this patient got periodontitis? You can't tell. You can tell what the history is, but until you pick up a probe, and you say, right, this guy's got bleeding on probing, suppuration, there's DNA evidence of bacterial contamination, you've got a certain genetic predisposition, etc., so you've got all the different interleukin-1 positive prototypes, etc., then you can say, right, this patient has a very high risk.

 

 

If you haven't done that, then how can you actually say that? You can never, that's why I love, people come on Facebook, and they look at your case, and they criticize it, left, right, and center. Or you get a case from another dentist, and you know, patients are, unfortunately they tend to withhold the evidence of what they said to the last dentist or what they've told them. Guys criticize everybody, but without actually the knowledge of what happened before.

 

 

It's exactly that type of scenario. Don't judge, don't criticize, don't say, it doesn't have to be this and it doesn't have to be that. You have to take a patient's needs into consideration, and not only patient's needs but also the patient's history. The patient's development of periodontitis, the patient's development of implants. What have they done? Are the implants there? Have they have had previous implants? Have they not? Have they failed? Have they not? Have they got peri-implantitis? Have they not? Are they stable?

 

 

There's so many factors that one can take in that you can never make that statement blanket for every single patient. You have to look at it from a case-to-case basis.

 

Howie F.:

All right, when you say, I get this question a lot, and we see it on Dentaltown all the time. People see a failing implant, and that's lost bone, but they're like, "But the implant's stable and it's performing its function." How do you help them diagnose [inaudible 20:43], when has an implant failed where it needs to come out, and when do you just manage peri-implantitis, and how do you manage that?

 

Howie G.:

Sure, that's ...

 

Howie F.:

Is that enough questions? See, I always throw out five questions, hoping one of them is good.

 

Howie G.:

They're all good questions but there's about two, three days of answers there. The crux comes down, I'll tell you what I do. I'll just give you an idea of what I do. A patient comes in, say it's my patient, because it's very different when you see somebody's else's patient to when you see your own.

 

Howie F.:

Yeah, yeah, absolutely.

 

Howie G.:

You know what I'm saying? Because when you see your own, you'll do everything to fix it. When you see somebody else's you're very quick to take it out. That's also wrong. I'll tell you what I do. The way I generally handle a patient, and I'll say to them, right, listen you've got, if you have signs of disease, number one, you've got an X-ray which shows you've got bone loss. If you've got bone loss on itself, and the bone loss is stable, there's no infection around the soft tissue, there's no suppuration, everything is happy and healthy, you might find that what the case is is really bone loss as a result of poor implant placement, which is lost bone, but it's stabilized.

 

 

That happens a lot of times, a lot of guys place implants in a ridge that's too narrow, but they squeeze it in, they say, "Oh, I'll just squeeze it in, I'll put the implant in." Not enough bone, bone disappears, but it stabilizes. Doesn't get any worse from there. It can last for twenty, thirty years. I mean, we have the oldest prostho practice in South Africa where that I work at, and we see implants fifty years old. Some of them that will blow your mind, stuff that's just not supposed to work, from what we know scientifically.

 

 

What happens is, is that we have a situation whereby, if you see clinical disease, bleeding on probing, suppuration, an X-ray where there's bone loss, and you also have like a kind of moth-eaten look, there's no good cortication of the bone. Then you want to treat the case, you know, but again, how much bone has been lost? Has it lost past to the lower third? Then maybe it's worthwhile extracting. If it's just a little bit of bone loss around the neck or up to halfway, okay, let's treat the case. Let's see how it goes. Give the patient a chance.

 

 

There's ways to do it, you can do it with laser therapy, which is closed therapy. You can do it with open therapy, you can try do regenerative therapy, there's lots of things that one can do. I always give it a try, even if it's somebody else's or it's mine, give it a try. The patient always knows that if it doesn't work after the first time, it might be better to take out and replace the implant, whereby we cover everything with bone.

 

 

It's not, again, I think the critical thing with any treatment that we do is, there's no fixed, it has to be this way, it has to be that way. You have to take it on a case-by-case scenario. You have to treatment plan your patients on a case by case, need by need, patient need by patient need, and determine where you go from there.

 

Howie F.:

Okay, when you see peri-implantitis, some people say that if the hygienist cleans it with metal instruments, she's scraping the surface, and making it worse, and she should use these plastic instruments. Some hygienists say, "I can't even remove the tartar with the plastic instruments." Some people are saying, "Well, why do I worry about scraping the surface when it's already got a rough-textured surface?" How do you treat peri-implantitis? Do you use a metal scaler around it, do you use a laser, do you put them on antibiotics, do you irrigate with Peridex or ...

 

Howie G.:

Again, you're asking a question that really is determined by each case. Do I think that plastic instruments are a waste of time? I agree with most hygienists that say they are an absolute waste of time, you cannot clean anything. Hard calculus is almost impossible to remove, but a lot of times, the hard calculus is really super crystal. Those aspects can be taken out, they can be thrown into ultrasonic bath, you can really scratch them off and then you can polish the abutments again, and you can put them back. So that's possible to do.

 

 

When the stuff is on the implant surface itself, then the implant surface is rough, so who cares if you take an ultrasonic scaler to it? Who cares if you take a profijet? Who cares what you do to it, because it's a rough surface anyway. I'm of the case where I kind of do a belt-and-britches approach, whereby we use laser, we use the biolase, the waterlase extensively to clean up the surface.

 

Howie F.:

Now is that the LANAP procedure?

 

Howie G.:

No, no, LANAP, the laser new attachment procedure is really around natural teeth, and it is a questionable treatment option, because there's no real scientific data to show it.

 

Howie F.:

What leads you to [crosstalk 25:15]?

 

Howie G.:

I know the PerioLase guys will disagree with me.

 

Howie F.:

That's PerioLase?

 

Howie G.:

That's PerioLase, and they're American, really, because I don't think you'll find many places around the world where they believe much in the LANAP. LANAP was a Ray Yukna type thing which happened in about 2003, they did one article and one abstract, and that's all that's been about LANAP. A lot of it's really, it's kind of anecdotal stuff that's coming out, and I have to agree that some of it does work, but it doesn't work as consistently as people want to think it works.

 

 

Basically, what we're doing, is we're using the laser to decontaminate the surface. If we get some regeneration around the implant, fantastic, but to say to your patient, "We're going to do this and we're going to get regeneration," I think really is bullshit. I think it's really, it's about ...

 

Howie F.:

When you say bullshit, more shit, or piled higher and deeper.

 

Howie G.:

All of the above. It's basically, it's again, it's a company that's pushing a technique.

 

Howie F.:

What's the company pushing LANAP?

 

Howie G.:

I think it's PerioLase.

 

Howie F.:

PerioLase? Okay. When you said you use a biolase, that's another question to me, because a biolase is a very high cost laser, and some people are saying, "Well, can't I do the same thing with a $2,500 AMD laser?"

 

Howie G.:

Yes, you can.

 

Howie F.:

With Alan Miller designed lasers.

 

Howie G.:

You can do it with the, you can do it, one of the lasers that works very well is the diode laser, which works very, very well, but there's one study really that shows well that just all you have to do is you have to cool well, and you have to just use it at one watt, and if you use it at one watt, and you use it for a certain period of time, cool the implant afterwards, you're going to have a fantastic result.

 

 

The other study is from the biolase group themselves, which show that if you use biolase, you cannot just use the, which is an erbium yag laser, you actually have to use the diode laser as well, because the diode works very well up against the spirochetes, and the erbium yag works very well against like the black pigmented and the a.a. bacteria. So it's kind of a dual therapy that a lot of the guys, and certainly there's a group in the U.K. that are pushing very much for a dual wavelength therapy of treatment of peri-implantitis.

 

 

I think that's really the right way to go. There's no gold bullet, and I don't think it works all the time, it works some of the time. It's really, for me, we use a combined approach, sometimes we do closed procedures, sometimes we do open. When we do open, we use laser. We use profijet, which I think the early studies on profijet using sodium bicarb as a polishing agent worked phenomenally well, but they discounted it, because they said, "Well, if you use profijet, it might alter the surface. If it alters the surface, it might now stop osteo-integration coming back." But we're not looking for osteo-integration coming back, we're just looking for health and looking to prolong the life of that implant.

 

 

It works very, very well, and what I'm saying is purely anecdotal, there's no scientific data for what I'm saying. In my hands that's the way we do it, and that's the way it works very, very well.

 

Howie F.:

Help this kid out. She's thirty years old, she's thinking, well, should I also give a round of antibiotics? I mean, will that help? Throw some systemic antibiotics at them?

 

Howie G.:

You know, antibiotics, you must understand that when we're dealing with any bioform, bioforms do not respond to antibiotics. A bioform is a closed, a city of bacteria, which kind of protects itself, it's got glycocalyx which protects itself. The antibiotics really are just going to affect the bacteria that are sitting within the soft tissue. If you have a huge soft tissue infection, then antibiotics are really going to help.

 

 

If you don't have a soft tissue infection, then the antibiotics are not going to do anything at all, because the bacteria that are sitting on the surface of the implant have to be removed mechanically, the same as you would do for periodontitis. Periodontitis, if you have the bacteria within the pocket, whatever you give from an antibiotic point of view is not going to impact on it. Obviously, tetracyclines do to some degree, because they get excreted in the gingival crevicular fluid, but not as much as what we need, so we have to have very high levels of tetracyclines.

 

Howie F.:

I'm just going through bullet points of the most common questions on DentalTown. Screw or cement a single.

 

Howie G.:

Well, I like to screw myself.

 

Howie F.:

I think we have something else in common. We're both Howie, we both like to screw. Gosh, darn it, the only difference is you have hair.

 

Howie G.:

Well, that's going. I think the world is moving back to screw retainder.

 

Howie F.:

Well, that just sounds good. Maybe there will be more world peace.

 

Howie G.:

Thank God for that.

 

Howie F.:

If the world could just do more screwing, we'll have world peace.

 

Howie G.:

There's no debate about it. I think Donald Trump might ... No, I won't say, because he might sue me, I better not say anything.

 

Howie F.:

I think the reason Donald Trump does not like immigrants is because all of his ex-wives are from Russia.

 

Howie G.:

Too true. The question is screw-retainder or cement.

 

Howie F.:

Screw or cement.

 

Howie G.:

I think cement is a huge causative agent of peri-implantitis. And I think the more we can stay away from cementation and we can stay towards screw retainder, better. Again, it's realistic, you know, because sometimes patients don't want to have massive bone grafts which sometimes are needed to get the implant in a position where you can get screw-retain. If you can place them in positions where, okay, the angulations can be corrected with angled abutments, but it means that you have to have cement retained, okay, but then it means maybe customized abutments, making sure that your cement margins are not deeper than a millimeter.

 

 

Because far too many guys are just putting normal, standard stock abutments on. The margins are three, four, five millimeters below the gum. You cannot clean the cement out for any money in the world, and it's causing a disaster long-term for the patients. Cement from my point of view, if I had a choice in my own mouth, in one of my children's mouth, in any one that I wanted to do, I want screw-retained, where I can.

 

Howie F.:

You sound very customer-centered instead of dentist-centered, you know, the customer is first. A lot of the younger dentists are confused because you say you want to implant, but they look at the health history, and they say, "Well, he smokes, or he has diabetes, or whatever, and I don't think you're a candidate for that." Some people just say, "I don't care if they smoke and have diabetes, I just place the implant, and I just tell the patient, they'll have a higher risk." When you look at the health history, are there things where, like if they smoke or they have diabetes, or they're on oral hypoglycemics or they're on insulin, do you just say, "Red flag, no."

 

Howie G.:

I think if they smoke, if they're smokers, and you say no, you'd have very few patients, so we have to treat them.

 

Howie F.:

Right, so you place a lot of implants in smokers.

 

Howie G.:

Yes, we do. There's no debate. There's no, I don't guarantee the implants, if the patient comes back and it fails, you have to take some responsibility for the fact that you are going to increase my risk. The fact of the matter is, yes, we do place them. Do they work in smokers? Yes, they do. Do they have a high risk? Yes, they do. But there's a lot of them that have absolutely perfect and no problems whatsoever, so how can we just say, make a blanket ban for everybody.

 

 

The fact of the matter is, is that I think there are a couple of factors. Do you have periodontitis? Are you a smoker? Are you diabetic? Because a lot of our patients are all those three together. You know what I mean? Those patients are the highest risk. If they're diabetic, are you controlled or are you not controlled? If you're controlled, okay, fine, we'll do it. Again, it comes down to how you motivate your patient. Because if they come, and they say, "Right, I'm a smoker. I've got diabetes, but it's under control." Obviously because they're diabetic and they're smokers, they most likely had periodontitis. Are we treating a loss of teeth as a result of the periodontitis, as we spoke about earlier?

 

 

The fact of the matter is, we can't throw them out, but we have to make sure that they understand, right, that if you are in that grade of patient, if you are in that category, you have to follow a really strict maintenance program. If you're not prepared to follow that strict maintenance program of literally three months [supported 33:03] periodontal therapy, and you fail, well, you have to take responsibility for yourself.

 

 

Do I deny them treatment? No, I don't deny them treatment. I'm not that kind of person. I'm kind of more pragmatic, and I say, right, as long as you understand the risk of what you are entering into, I'm prepared to treat you. If you are stupid and you're not prepared to take my advice with regards to the risk factors and how we need to reduce and make sure and look after, etc., then that's your own problem.

 

Howie F.:

And you know what? I love crazy patients, because if I go back twenty years, the craziest patients I ever had, hell, they were all family. My dad, he never followed any instructions. He was the craziest. I love crazy patients, and we just coach them, do what they say. I got to ask you a very delicate question, because you're a periodontist, and implantologist. A lot of these young dentists are confused because they got one periodontist in their town saying, "You need to do gum surgery, and we need to do the gum tissue and all that stuff." Then another periodontist telling them, "Oh, that's bullshit. Just pull the tooth and go straight to titanium."

 

 

You, you're out of all the nine specialities, endo, perio, pedo, prostho, your profession, I believe, changed more in the last thirty years than pediatric dentistry or orthodontics or oral surgery. I mean, yours, when I got out of school in '87, it was only perio surgery. Now some have taken it to all implantology. Is there a balance? Let me give you a specific. It's a three-rooted tooth. There's trifurcation involved. Or there's a mandibular molar, and there's bifurcation involved. One periodontist wants to do perio surgery, one wants to say, "Oh, screw it, let's just pull the tooth and go to titanium." How does the general dentist balance that treatment plan, when you have two specialists kind of leaning two different ways?

 

Howie G.:

You see now, this is again, where I find both of them wrong, because the crux comes down to, what are the patient's needs? Until you treat the patient's needs, you're not going to have a practice that's going to be successful. If the patient comes to you and they say to you, "Listen to me. I've got this case." Now if you came to me and you said to me, "Listen I've got a trifurcation or a bifurcation, and there's really, I've got, it's just not stable." Is it stable, how long has it been stable?

 

 

You know, there's so many factors, it's just not an easy question. You might find that the patient has a trifurcation, and there's no pocketing, they've got recession, they've got massive clinical attachment loss, but there's no pocketing. The patient is managing to clean. Now the patient comes, oh, well, we must extract the tooth. Why? Why must you extract the tooth? Meantime, the patient is like, "I don't want to extract the tooth." Of course, you don't need to extract the tooth. Keep the tooth, we'll keep it.

 

 

If it's continually breaking down, you can advise the patient, say, "Listen to me, this tooth is breaking down continuously. There is a furcation. We know from our scientific data that with furcation areas, they tend to break down on a regular basis, and you will probably lose this tooth. Maybe it's a good idea for us to extract the tooth and place an implant." "Doc, I don't want to place an implant." Okay, fine, but you understand I've explained everything to you. Let's try and save the tooth, but let's keep going with it, but know that the implant is probably the better option here.

 

 

That's when you're starting to treat the person that's sitting in the chair, and not the dogma that you read in a scientific article. I think that is probably the most, and you know, you talk about successful practices. I think one of the critical issues for successful practices is most guys try and shove their dogma onto the patient, when in actual fact there are a lot, there's so much variety in the way we can treat a patient. There's so many possibilities, there's so many paradigms that we could take to try and treat the patient.

 

 

Yes, sometimes patients take the wrong road, and we even watch them taking the wrong road, but it doesn't make them wrong. It's just what they need, and we will at some stage get to where we want to go, where the patient says, "Okay, [shit, it's 36:58] actually not working, let's go your way." The patient walks out of there thinking, you know, the doctor has actually listened to what I need. I'm not walking out of here thinking that I don't have a choice in what I'm going, and you know, the patients are much smarter than they were in the old days. The white coat means nothing anymore. The internet, Dr. Google, means more, you know?

 

Howie F.:

Who cares if you're a doctor? I Googled it.

 

Howie G.:

Exactly, Dr. Google is way smarter than you are. And they're right, because a lot of the dentists don't read Dr. Google, or they don't go to conferences enough to understand that there are lots of different options for the patients. I think, if I ever say to a young guy, if you want to be successful in practice, listen to your patients. Listen to your patient need, because their main complaint is your main way that you're going to deal with that patient.

 

 

It might not be perfectly the way that science says you must, but it's right for that patient. It will change and it might change over time, but if you deal with that, you'll be successful, because your patients come and they're feeling, "Wow, this guy really listens to me. I feel like I'm heard, I don't feel like I'm just another, I'm just another person that just like, oh, no, no, we need to do surgery here, we need to do a root planting here." That's the way I do it, and that's the way, and you either fit in or [inaudible 38:16].

 

Howie F.:

You know, one of the biggest feedbacks we hear from dentists going to conventions all over the world, they say, you know, in the United States, if you do a crown, if a crown is sent to a lab, 96 times out of a hundred, it's a one-tooth impression. You go to the seminars, and it's all full-mouth reconstruction. Ninety-six times out of a hundred, when an American does an implant, it's for one tooth, and it's usually a molar, it's usually a first molar. When you go to the implant courses, it's full-mouth reconstruction.

 

 

Going back to just the single unit, just to replace a molar, some people say, "There's no need to bone graft, it's a molar, it's a big tooth. Just place the implant and let it heal." Other people are saying, "Oh, no, you got to bone graft this thing, and you got to draw blood and you got to spin the blood and do all this, and mix it with the bone, and it's a big concoction." Then other people say, "Dude, I've never done that, and I have success." Do you need to bone graft a single unit? Is drawing blood and spinning platelets worth all the time and money? Or is that more overkill?

 

Howie G.:

It's all bullshit.

 

Howie F.:

It's all bullshit. We Howie, we Howie, we call bullshit.

 

Howie G.:

Let's go through this because this is actually a bugbear of mine. Again, you know, you ask me a question, you're stating things, it has to be this way. It doesn't ever have to be this way or that way. It's what the patient needs. This is one of the biggest problems, where guys, "Yeah, I have fantastic success." Anecdotal statistics are not success. Just because your patients don't come back doesn't mean they're not going somewhere else to fix your mess.

 

 

It irritates me, that, because what happens is, there's a certain amount, there are rules with regards to how much bone you need. There are rules to how much soft tissue you need. If that person has a molar site that has enough bone, then you don't need to bone graft. If that person has enough soft tissue, that person doesn't need a soft tissue graft. If that person doesn't have enough bone, that patient needs a bone graft. If they don't have enough soft tissue, they need a soft tissue graft. It's as simple as that. What are the patient needs? Is there attached gingives or no attached gingive? All these criteria have to be looked at on a case-by-case scenario.

 

 

You often, and I tell you, I say to all my students, when they come to our academy, I say to them, "How many of you have placed a four millimeter implant into a six millimeter ridge?" Everybody sticks their hands up. This week, yes, everyone, because we're just going to squeeze it in because there's enough bone, and that's bullshit. We start looking at the peri-implantitis data, where some of the statistics now are showing us as high as 50 percent of our cases are coming back with peri-implantitis. Why? Because we're failing to develop our implant sites well enough. Most people just come, "I don't need to do that, because it's worked for me all these years." I mean, what kind of bullshit is that? I mean, if we ever, if we ever turned around and said that, would we ever have developed to where we are today? No chance.

 

 

The fact of the matter is, if you look at your patient, you say, we know from studies that if you have two millimeters of bone on the outside of an implant, you are going to have a stable implant over the long term. If you don't, if you have one millimeter, it resorbs, we know that. It's scientifically proven. It's clear as day, but most people continue, "I don't need bone grafting, I just squeeze it in." Why? Because they don't know how to do bone grafting effectively, or because they want to rather put the implant in and get the crown because that way, they get more turnover, faster turnover.

 

 

The fact of the matter is, is that we need to take care of our patients. If you want to keep, again, we talk about a successful practice is not a practice where you have to move every seven years because your mistakes are coming back. A successful practice is where your patients are coming back and you're seeing success time after time after time. That's what our scientific data is starting to show us. There is no right or wrong answer, there's a case by case, and it goes for every question that you ask me. You know, we must do this or we must do that.

 

 

There is no right answer. If there's no bone, develop bone. If there's no soft tissue, develop soft tissue. If there's enough, you don't need to do bone grafts. Anyone who says to me, "I never have to do bone graft," in my opinion is an idiot.

 

Howie F.:

When you bone graft ...

 

Howie G.:

Was I strong enough on that?

 

Howie F.:

Yes.

 

Howie G.:

Good.

 

Howie F.:

When you bone graft, do you ever draw blood and spin platelets?

 

Howie G.:

All the time.

 

Howie F.:

All the time. When you bone graft, do you try to use that patient's own bone? Do you use other dead people's bone, or do you use cow bone? What do you like to use?

 

Howie G.:

We like to use Harley Davidson bone.

 

Howie F.:

Harley Davidson bone?

 

Howie G.:

That's when they come [inaudible 42:55]. That's the guys that come short on their Harley Davidson. I'm just kidding. Okay.

 

Howie F.:

That was a good one.

 

Howie G.:

The fact of the matter is, again, there's cases and there's cases. Let's talk about it, because again, what do I use? I use everything. If you said to me, Howard, what do you use as a preference, I'll always use the patient's own bone. Why? Because it remains the gold standard. Do I get the best results with the patient's own bone? Without a doubt. In my experience, and with my knowledge of bone grafting and the way that I do bone grafting, I get phenomenal results that nobody can ever question, because I've got the results, I show them on Facebook regularly. Ken loves them.

 

 

The fact of the matter is, you can't compare, it's incomparable when you use autogenous [bone 43:46]. There are two factors. Number one, a lot of people are not okay with taking bone. Number two, there are a lot of patients who are like, when you say to them, "Excuse me, I'm going to take bone from your ramus," it's like watching a Mickey Mouse movie. It's like the guy sitting in the chair and the ghost walks out the door, and all you see is the body left there. The ghost is like out of there, there's no way he's taking bone, and the body is just sitting there doing this, because the patient is not going to have that.

 

 

If the patient, again, it comes down to patient-centered treatment. What would you like? This is the best, then they say, "Okay, listen, I want you to do the best. If you think that autogenous bone is going to be the best, let's go for autogenous bone." Do you know you're going to have a second site that's going to be more painful, blah, blah, blah, blah, you're going to have more risk, or this, okay, now I understand that, but my success rate is higher, and we know it, because it still remains the gold standard.

 

 

If the patient comes there so petrified, like, "Howard, listen there's no ways you are taking any bone out of my body." Okay, listen, there are other techniques, but these are the complications associated with it. Maybe there's less success, maybe there's more risk of perforation and exposure of membranes. Do you understand that risk? "Yes, doctor, I understand that risk." Okay, cool, let's go that way. But you must understand that these are the risks associated with it, and we can do whatever you want to do, but just know exactly what the problems are and where we are going to go.

 

Howie F.:

Talk about your academy. What is your, what's the website, talk about it, what's that all about, your academy.

 

Howie G.:

Well, basically, we have, you know in South Africa, the universities don't do a lot of postgraduate training, so for the last, I mean, I've been teaching implantology for about twenty years. I know I look very young and all that.

 

Howie F.:

You do look young, you look good, buddy. You look damn good. How old are you?

 

Howie G.:

I'm fifty this year.

 

Howie F.:

Fifty this year, the big Five-Oh.

 

Howie G.:

I've been teaching implantology for probably more twenty, twenty-five years, around there. Around, we were very integral in developing postgraduate diplomas at two universities, that's Stellenbosch and University of Western Cape. Then kind of things politically ...

 

Howie F.:

What was that university?

 

Howie G.:

University of Stellenbosch, and University of Western Cape. Stellenbosch is no longer a dental faculty, they've merged with University of Western Cape. We kind of moved away after a while, and went on our own for whatever reasons, makes no difference. For the last fifteen years now, we've had a private academy, which is pretty much the only private academy where we teach implantology from start to finish, whereby you can come and you can learn, this is an abutment, this is an implant, this is how you put the implant in. You can walk away the next day and place an implant.

 

Howie F.:

What's the www?

 

Howie G.:

That's www.implantacademy.co.za.

 

Howie F.:

Right [inaudible 46:23]. It's www what?

 

Howie G.:

Dot implantacademy.

 

Howie F.:

Implant academy.

 

Howie G.:

Dot co dot za.

 

Howie F.:

Dot co dot za.

 

Howie G.:

Za is for Zuid Afrika. That's still the German, Zuid Afrika.

 

Howie F.:

Seriously, that's where that comes from?

 

Howie G.:

Crazy, they still keep that.

 

Howie F.:

Are you serious? Because I wondered why it was ZA. Is SA already taken from another country?

 

Howie G.:

Probably is, probably is, like Saudi Arabia?

 

Howie F.:

So that's what ZA, it's German for ...

 

Howie G.:

Zuid Afrika.

 

Howie F.:

For Zuid?

 

Howie G.:

Zuid. Z-U-I-D, Zuid Afrika.

 

Howie F.:

And that means South?

 

Howie G.:

South.

 

Howie F.:

Huh. You know, one of the greatest marketing things you could do, is your implant curriculum, how many weekends is it?

 

Howie G.:

We have around six weekends.

 

Howie F.:

And each weekend is how many days?

 

Howie G.:

Two days. We have an international course as well, which is three days.

 

Howie F.:

What you do is, if you have six two-day weekends, do an Online C course on DentalTown, make it free or low cost or whatever, like an hour and then they get to meet you, they get to see what you're talking about. Then when you finish, you say, you know what you ought to do ... By the way, to my homies out there, 83 percent are from the United States, there's nothing cooler than a vacation to South Africa. I mean, you got to go to these game preserves. We've been seeing rhinoceros, it's the coolest damn country in the world. You're in Cape Town?

 

Howie G.:

Cape Town.

 

Howie F.:

Cape Town is supposed to be the coolest city, I haven't seen that.

 

Howie G.:

It's the most beautiful city in the world.

 

Howie F.:

Yeah, so it would be a world-class vacation, and make it all tax deductible. By the way, you young kids in dental school don't know what that means. If I pay for a course for my business, and the course costs a dollar, I pay Howie a dollar. But if it's a personal vacation in South Africa, I have to pay taxes first, so I made a dollar, I pay thirty-eight cents to the federal government, now I have sixty-two cents, so now I'm going to South Africa post-tax dollars. You could go see South Africa on pre-tax dollars. So, Howie, you have six two-day courses. Go through that. What's the difference in course one, two, three, four, five six?

 

Howie G.:

Basically what we do is we take our dentists through a gradual internship through implantology. We'll start off with basics, which is really right from a guy who's never placed an implant. You find a lot of guys that come out of university who don't even know what an implant is. We start from there, and we teach them the basic, basic, of taking impressions, placing a basic implant, etc., in healed bone. Then our second course is really, moves on to immediate placement, immediate provisionalization, minor bone augmentations, which are really small, using a synthetic materials from human bone to xenografts to things like that and membranes.

 

 

Then we move onto soft tissue, which I think is probably, first it's the most popular course because it's the most important course. It's actually dealing with soft tissue. How do I expose properly, how do I actually handle the soft tissue? Because a lot of times what patients see, is they see only, they see the pink and the white. They don't care what the bone looks like. That's where guys, we mentioned earlier about "I have fantastic success." They have fantastic success because they don't actually know what's going on with the bone, and it doesn't matter because the patients don't care. Soft tissue is important for bone, bone is important for soft tissue. It's so important to have a full understanding of both.

 

 

After soft tissue, we then go to sinus augmentations, we then have a course on ridge split augmentations, and we then have a final course, which is an international three-day course, where we really do the most advanced soft tissue, the most advanced bone block courses, where we teach different types of courses with regards to specific techniques where we get phenomenal, long-term predictable results with bone augmentation. We talk about the newer technologies, like partial extraction therapies, socket shields, and things like that, which are very, very cutting edge at this point in time and not what a lot of people are teaching. That kind of covers really every aspect of implantology that you'll ever need to know.

 

 

We also have another course run by two prosthodontists, where they teach prosthodontics from basic prostho to advanced prostho. You know we spoke about full arch cases, doing full arch cases, doing single cases and how to manage those different cases.

 

Howie F.:

I'm just going through more of the most common questions in implantology. Surgical guide or no?

 

Howie G.:

I think the guided surgery is something that's advanced, it's not basic. I think what happened was there was a lot of emphasis in the early days, especially when NobelGuide came on the market, they kind of pushed it as "teeth in a hour." We have a saying for that, it's called "teeth for an hour," where things didn't last too long because of the way things were managed. But essentially it's advanced work [that 51:47].

 

 

Guided surgery, we don't do a lot of that. There's certainly a place for it. I think there's a lot of groups that do phenomenal work in that, and there's an Italian group, the Agonini Brothers who are superb in that. I wouldn't say come to South Africa to do that, because we're not as strong in that as some of the other guys are. There's lots of places in the world to do that. I think it's a good procedure to learn, but I think it's an advanced procedure. It's not a procedure for basic guys.

 

Howie F.:

Well, I meet, if I lined up a hundred dentists in a row that have all placed over 2,500 implants, it seems like 95 percent of them tell me they never use a surgical guide. Is that not really real, or is that what you see, too?

 

Howie G.:

I think anyone that doesn't use a surgical guide is an idiot, and I say that without any compunction. I think you are, you're an idiot if you don't.

 

Howie F.:

You don't use the surgical guide on every implant?

 

Howie G.:

You don't have use a guide, you don't have to do guided surgery, but you have to have a surgical stent for every single case. So often, we look at the Facebook stuff, I mean, there are so many people out there. They just kind of draw, there's no guidance as to where they're doing. The fact of the matter is that implantology is prosthetically driven. Until such time as you have worked out where the prosthetics are going, you should not be placing implants. If that's the way you're doing it, you're doing it wrong.

 

 

Yes, guided surgery is not necessary for each case, but a surgical stent, which has been worked out by your prosthodontist or a prosthetic dentist who is going to do the restorative work, has made that so that you can work according to that and see .. Now it comes, do I need a graft or don't I need a graft? The fact the matter is, if I cannot get the implant into the correct prosthetic position, then I need to graft. If I can't, don't just put it anywhere, and then you end up with a sidewinder implant that has to have a custom abutment that costs South Africa's entire gold content to try and [build 53:52] the damn thing.

 

Howie F.:

On the same deal of a surgical stent or not, say the dentist only has a pano, only has 2D radiology, do I have to use 3D? I mean, was 3D a game changer where I have to use 3D, or can you still do implantology with 2D panos and PAs and [subs 54:14].

 

Howie G.:

I come from a time where we had no, we had 3.75 millimeter implants, that's all we had. I come from a time where we had Gortex membranes, that's all we had, we had nothing else. As we've developed, and as 3D has become available, 3D Cone-beam CT scan is a massive game changer. I think, and it's something that we teach categorically, CBCT is the bare minimum for implantology, because the amount that you see, and the amount you can decide and guide and see, with a proper surgical and radiographic stent, you can then plan the case properly. If you are not doing that and you make a mistake, and you end up in court, you deserve to be there.

 

Howie F.:

Are you agnostic to CBCT or do you like any brands?

 

Howie G.:

I think whatever brand that works for you is fine. I'm not a brand person, I'm not a brand person for implants, I'm not a brand person for any certain thing. If it works for you, use it.

 

Howie F.:

Okay, I've got another tough question for you. On DentalTown, one of the most common questions that dental students ask is, should I specialize or do general dentistry? I have to tell you, of all the nine specialties out there, yours changed the most. There's kids out there really stressing, a senior in dental school, they're thinking, "I'm thinking about a periodontist." But then they're thinking, "God, what even is a periodontist?" What would you say to a kid who is a senior saying, should I be a periodontist? What would you say?

 

Howie G.:

You know, I don't know, maybe I'm the wrong person to interview for this. It really, it depends on what his passions are. To me it's about passion. If you have a passion for surgery, which I have a passion for surgery, I have a passion for surgery, I have a passion for teaching. If that's your passion, then you can go into maxillofacial, or perio. Are you big into jaw surgery and bone surgery? Go into maxillofacial. If you're into the aesthetics and the soft tissue and the fine detail, go into perio.

 

 

If you find that, shit, you know, you really enjoy the whole sphere and the multidisciplinary, go into general dentistry. You can be a phenomenal general dentist that does implantology, does bone grafting, does soft tissue grafting. I know, I mean, the guy that taught me was probably the best GP in South Africa. My best friend, passed away many years ago, young guy, but what a phenomenal guy. He used to teach the specialists how to do implants. There is no, again, there's no right or wrong. It's really about your passion. What do you like, what do you enjoy?

 

Howie F.:

If someone said to you, you have to pick one. Are you a periodontist or an implantologist? If you could only pick one, what would you say?

 

Howie G.:

I'm an implantologist.

 

Howie F.:

Implantologist.

 

Howie G.:

Who acts like a periodontist.

 

Howie F.:

Who acts like a periodontist.

 

Howie G.:

And is also a hybrid oral surgeon. I would say I'm really a hybrid, and I think that's what makes me successful, because I can handle bone well, I can do massive bone augmentations, from hip, from wherever, as an oral surgeon would do. I can also handle soft tissue the way a periodontist can do, and I think that's what makes my success.

 

Howie F.:

You've been doing this for twenty-five years.

 

Howie G.:

Pretty much.

 

Howie F.:

A quarter of a century.

 

Howie G.:

You make it sound like such a long time, for God's sake.

 

Howie F.:

Well, it is a long time, because these kids are coming out of school at twenty-five and you've done it twenty-five years. That's they they love this show, because you know, they're just out of school, and they're bright-eyed and bushy-tailed at twenty-five, and they get a talk to a couple of old guys who have done it longer than they've been alive. What has got you excited and passionate about periodontics now? Why, I mean, you've made enough money, you could retire and just be fishing for Great White sharks off of, the rest of your life.

 

Howie G.:

Have you been speaking to my ex-wife?

 

Howie F.:

Why, you obviously don't, I mean, you could have retired. Why are you still passionate? What's got you excited about your career?

 

Howie G.:

I just, I don't know, I've always loved perio, I've always loved surgery. I'm passionate about it, it's passion. It's really passion. I'm passionate about what I do. I love it, and I love working every day. If you're not passionate about it, go sell insurance. You can make the same money, probably more, and not have to work the same hard hours. If you're not passionate about what you do, you're in the wrong profession.

 

Howie F.:

Well, I want to say that, you know, it was an honor to come down and speak at the SADA, South African Dental Association. Like I say, you've been an idol of mine for decades. When I came here, all of my friends in Phoenix, I said, "I'm going to South Africa," the only thing they said was, "Oh, my god, that's where Howie Gluckman lives." It's embarrassing that of our 350 courses, most of those on DentalTown were made by Americans. It would give so much international prestige, it would be such an honor if you'd ever make us an Online C course.

 

 

The one thing I can promise is, there's no platform for Online C that's viewed more around the world. Two hundred and twenty countries watch every single course we put up. Somebody, if you ever got the free time, I wish you'd do it. I also wish you do it because I know my homies, and if they just see an ad in Dentaltown that says, go see Howie Gluckman, and they're like, you know, an ad all the way to fly into South Africa, that's a big sketch. If they get to listen to you on the podcast, or they get to watch your Online C course, I think they'll fall in love with the man. I know I have fallen in love with you and have for yours.

 

Howie G.:

I suppose a kiss is out of the question.

 

Howie F.:

Hopefully some day you'll grace us, plus there would be a lot of international prestige for Dentaltown. Howie, thank you so much for spending an hour with me. Now I'm thinking, Ryan, that maybe I should quit going by Howard, because you know what I don't understand? Who's the only people that call me Howie? My mom and my five sisters, it's Howie. When you, when I see you, I always think to myself, why did I even go by Howard? Everyone that loves me that most ...

 

Howie G.:

Calls me Howie.

 

Howie F.:

Calls me Howie. So why do I go by Howard? I'd rather my homies love me and call me Howie, like my mama does. But Howie, seriously, thank you for all that you've done for dentistry. You're a legend and thank you so much for spending an hour with me today.

 

Howie G.:

Thank you, thank you for all your time and effort. The gin and tonic was fantastic.

 


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