Dentistry Uncensored with Howard Farran
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761 Results-oriented Oral Implantology with Dr. Louie Al-Faraje : Dentistry Uncensored with Howard Farran

761 Results-oriented Oral Implantology with Dr. Louie Al-Faraje : Dentistry Uncensored with Howard Farran

7/5/2017 5:31:34 PM   |   Comments: 0   |   Views: 255

761 Results-oriented Oral Implantology with Dr. Louie Al-Faraje : Dentistry Uncensored with Howard Farran

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761 Results-oriented Oral Implantology with Dr. Louie Al-Faraje : Dentistry Uncensored with Howard Farran

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VIDEO - DUwHF #761 - Louie Al-Faraje


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AUDIO - DUwHF #761 - Louie Al-Faraje


Dr. Louie Al-Faraje literally defined and authored the art of Oral Implantology. As a leading authority, he created many classifications and techniques, the standards by which oral implantology surgical procedures can be successfully performed. His name has become synonymous with results-oriented oral implantology treatments around the world.

A highly experienced clinician, educator and innovator, Dr. Louie Al-Faraje is continually advancing the protocols for oral implantology surgical treatments. His California Implant Institute in San Diego, California utilizes today’s most innovative and effective clinical solutions to create and ­maintain optimal oral health using dental implants and bone grafting procedures.

Additionally, he is a board-certified, practicing oral implantologist in San Diego California, as well as an author and educator, who presented hundreds of lectures and trained hundreds of dentists throughout the world.

Dr. Louie Al-Faraje received his medical education at Kiev Medical School/ faculty of Stomatology and followed by postdoctoral training at Loma Linda University in California.

He is the author of a bestseller textbook “Surgical Complications in Oral Implantology” published by Quintessence 2011 and available in 7 languages, “Oral Implantology Surgical Procedures Checklist” Quintessence 2012, “Surgical and Radiologic Anatomy for Oral Implantology” Quintessence 2013 and is on the editorial board of the journal of Oral Implantology (JOI).

www.implanteducation.net


Howard Farran: It is just a huge honor for me today to be podcast interviewing a legend in implantology, Louie Al-Faraje. He is just crushing it. He literally defined an authored the art of oral implantology. As a leading authority he created many classifications and techniques, the standards by which all implantology surgical procedures can be successfully performed. 

His name has become synonymous with results-oriented oral implantology treatments around the world. A highly experienced clinican, educator, and innovator, he continually advances the protocols for oral implantology surgical treatments. His California Implant Institute, in San Diego California utilizes today's most innovative, and effective clinical solutions to create and maintain optimum oral health using dental implants, and bone graphing procedures. 

Additionally, he is board certified, practicing oral implantologies in San Diego, California as well as an author and educator who presented hundreds of lectures and trained hundreds of dentists throughout the world. He received his medical education at Kiev Medical School, Faculty of Stomatology, and followed by a post-doctoral training at Loma Linda University in California. 

He is the author of a bestselling textbook, Surgical Complications in Oral Implantology, published by Quintessence, and available in seven languages. Oral Implantology Surgical Procedures Checklist, and Surgical and Radiological Anatomy for Oral Implantology, and is on the editorial board of the Journal of Oral Implantology. You've actually written four textbooks, haven't you?

Louie Al-Faraje: Yes, so the fourth one, you had not named it's called Oral Implantology Review Preparation to pass the board exam in oral implantology.

Howard Farran: Man, how do you have the discipline to write four textbooks? I mean, most people maybe they'll write ... What? Maybe one out a of 10,000 write one. How do you have the discipline to write four textbooks?

Louie Al-Faraje: Well, simply these topics are missing from the oral implantology library, if you will. Since I am in the education business, if you will, so I have the material, and I have the idea. Of course, you have to put quite a bit of time behind the computer. It is roughly 2,000 hours for a publication, so you just have to sleep four hours a day for a while.

Howard Farran: Are you one of those guys who doesn't sleep much?

Louie Al-Faraje: I sleep six hours a day.

Howard Farran: You sleep six?

Louie Al-Faraje: That's plenty for me.

Howard Farran: Yeah.

Louie Al-Faraje: Yeah six hours.

Howard Farran: I want to start off with this. Last week, the United States just graduated 6,000 dental students from 56 schools, and every one of them says the same thing. "We didn't place one implant in dental school". How do you go from, "I just walked out of school and I never placed one," to where you are, you've placed like 4,000 implants, and wrote four textbooks. How does she go from zero to one? What advice would you give her if that was your daughter walking out of dental school?

Louie Al-Faraje: Well, first of all, you need to have enough didactic knowledge, because there are some live patient hands-on courses available, which is fantastic because when I started in '95 there was no live patient hands-on courses. You really had to start on your own patients, hopefully, with the supervision from the sales representative, or a friend who might not have more experience than you. Nowadays, doctors who are making entry to implant dentistry are lucky because there is plenty of good courses available for the didactic knowledge. A few courses available where you have the opportunity to place implants on live patient's under supervision. 

The way to go is to respect the basic sciences, review anatomy, and have a good base on the surgical principles. Then, have enough CE courses, and then attend enough hands-on live patient courses, so the learning curve is as short as possible when you do the procedures on your own patients. There's no way to avoid learning curve, as you know, but with more courses, with more hands-on training, the learning curve would be quite shorter.

Howard Farran: One of the differences between baby boomers and millennials is I think the lowest cost, highest quality, faster, easiest, lowest cost way to learn, is a textbook. You've written four of them. It seems like today so many people don't read textbooks, they just fly across the country, spend lots of money in a course and drive back home. Like I say, I'll never forget going to Carl Misch in like 19 ... I think it was like 1990, and people were asking all these questions. I'm like, "Dude, that was in the first chapter of his book. I read the entire book like a novel, before I came down here. Hell, if anything, buy the textbook, at least read it on the plane flight to the course."

It just seems like it's just the ... I mean you spent 2,000 hours writing a book, so it's all there, it's succinct, it's perfect. I just think it's the lowest cost way to learn all the didactic knowledge of anything, is a textbook. Do you think us, 50-year-old plus guys read more textbooks than the 30 and under millennials?

Louie Al-Faraje: Yes, but what you are talking about was taken in consideration in my books. If you look how I structured my books, for example, the first one, Surgical Complications in Oral Implantology. The book is made ... covered, if you will, actually, 75 complications, and each complication is fairly separate from the other complications, and each complication is anywhere from one, to three, or four pages. It's very easy read, and literally every one to four pages are totally separate, I mean in a way, from the rest of the complications. 

Each complication, we discuss how to prevent it first because it would be easy to prevent the complication from happening, rather than deal with it. Then if it happens, we talk about how to treat it, and how to prevent it from happening. It's very easy read, and for those who want to read very quickly, you will go to that complication and from one to four pages you will have a very thorough, in my opinion coverage on it. 

The same thing with the anatomy. We have roughly 25 anatomic landmarks that we need to be aware of and avoid when doing surgical implant dentistry. It's one anatomic landmark at a time, and it covers the ... we have radiographic images of this anatomic landmark, most of them. Then, we have very good illustrations, clinical cases, clinical pictures and we have also cadaver shots. Most anatomic landmarks are covered from four angles.

Again, it's a very easy read because you have around 20 surgical oral anatomic landmarks and you can do one at a time. You should have very good thorough anatomic knowledge, because it's a basis for clinical implant dentistry. It was taken in consideration, the fact that people these days want information very quick, and in a very easy format. I think all my books deliver the topics that they cover, and very easy quick.

Howard Farran: I know everybody is commuting to work right now, and it's hard to take notes. What I do to make them find you easier, is I retweet your last Twitter, so you're @LouieAlFaraje, so I just retweeted you to my 21,000 Twitter followers. I'm taking Twitter more seriously, since now that I realize you can become the President of the United States, just if you have five million followers. If my homies to go ImplantEducation.net, what are they going to find on that website?

Louie Al-Faraje: We've been giving seminars since 2002. Over 2,000 dentists took one or more of my seminars. We have around eight or nine different courses and all of them, almost all of them a week-long. We have didactic courses in San Diego, and we have live patient surgical externships, if you will, in Rosarito, Mexico. Only 30 miles south of the US Mexican border. The reason we do it in Mexico is because-

Howard Farran: From what U.S. city?

Louie Al-Faraje: From San Diego.

Howard Farran: Okay. It's by Tijuana, then?

Louie Al-Faraje: It's like 30 miles south of Tijuana. Tijuana is right on the boarder.

Howard Farran: Okay, so 30 miles south of Tijuana.

Louie Al-Faraje: Yes.

Howard Farran: My favorite city on earth.

Louie Al-Faraje: What is it?

Howard Farran: Tijuana is my favorite city on earth, you can get more trouble in Tijuana in one night. Yeah, I don't know where else you could go in the world to get that much trouble. That city is a blast. It's 30 miles south of Tijuana is your hands-on surgical courses.

Louie Al-Faraje: Yes, we have a whole building, free standing, and a very nice area right on the beach, in a nice gated community. We have three different courses that we provide. Each of them six days long. We have Implantation seminar, we have one Grafting seminar or course, if you will, and we have All-On-4/Full Arch Immediate Loading seminar. Most doctors take all three. Some of them already experienced, they take only the one Grafting one, or only the All-On-4 Immediate Loading Full Arch course. We have, again, many different courses in San Diego from Oral Sedation, to CAD/CAM, full week, to Advanced Prosthodontics also full week, and our flagship, the Fellowship Program. Three sessions, six days each. You can go as far as you want with the California Implant Institute in implant education.

Howard Farran: My number one fantasy, right now, would be to have you make a one-hour online course kind of summarizing a week-long course, because it's a ... I think that would be amazing. Also, in your online course, to talk about which textbook would be the best didactic preparation, so that when you go there, you're not the one guy raising your hand saying, asking 36 questions that everybody else knows. Man that's amazing. Your three hands-on courses, Implant Placement, Bone Grafting, All-On-4, you said that's six days long. What is that? Monday through Saturday?

Louie Al-Faraje: On Monday, we take them from San Diego to our clinic in Rosarito, Mexico, it's around one-hour drive on a nice bus. Then, we tour the clinic, we have a couple of hours lecture on Monday. We get dinner. Then, the actual surgical training starts Tuesday morning. Tuesday, Wednesday, Thursday, Friday full day Saturday, for five days usually we start at eight in the morning, and we're not done until 9 p.m. We do roughly 150 to 180 implants every program in the Implantation course.

For the Bone Grafting course, each doctor is guaranteed four bone grafting surgeries, and of course, doctors are divided in groups of two. When a doctor doing the work, another doctor is assisting, so you have double the exposure in any of the courses you attend. Then, we have the All-On-4 course where you do two full arches with the restorative phase of implant dentistry, in that particular course, so you should be ready to provide these services to your patients when you go back to your offices, with the shortest possible ...

We are providing also great service to our patients. We're giving them their third set of teeth, so it is definitely the highest level of dentistry you can provide with my [inaudible 00:14:01] crowns, and fillings, and dentures and all that stuff. You are providing a very high level of service to patients who already lost teeth. Partially edentulous or fully edentulous. Implant dentistry is very predictable, and if you follow the rules, and you do the procedures to those patients who are candidates for those procedures, it's extremely predictable, and very good profit margin.

Again, we have to make sure we make enough money, so our offices stay open and we can help more people. It's a fantastic thing, and it's ... considering what is the tuition these days for dental schools, I don't think ... I don't know how you can make it without offering implant dentistry services in your office these days. I don't think you can survive with half a million dollar tuition, doing only crown and bridge work. I think implant dentistry is a win-win for the doctor and the patient. We are doing implants. We're stopping the bone loss after the tooth loss, and at the same time, it will enable you to pay the crazy overhead that you have these days. From the cost of starting a practice, to the tuition, quite faster than without implant dentistry.

Howard Farran: When you go around the world, I mean, when you lecture in Tokyo, Paris and London, me and Ryan lectured there last year. The governments are only paying $100 for a molar root canal. When you go around the world, in the United States, PPO's have lowered the fees about 40%. When you go into procedures like implants, and Invisalign, where a government agency, or a PPO isn't setting the fee, you can have really nice profit margins. A lot of dental offices around the world, the reason they are profitable is because they might pull out an implant case and an Invisalign case out of their NHS population pool, or their PPO pool every week and it's those high margin procedures that are profitable, that are paying the bills. How much money does each week cost for these three hand-on surgeries? One week implant placement, one week bone grafting, one week All-On-4, what is the cost of all that?

Louie Al-Faraje: Each course is $12,900.

Howard Farran: Do you offer financing for dentists?

Louie Al-Faraje: We do through The Lending Club, and they can apply though our website.

Howard Farran: You imply that through The Lending Club.

Louie Al-Faraje: Yes.

Howard Farran: Nice. Then, those are the three hands-on, an hour south of San Diego. Then, you said in San Diego you have three didactic courses, Oral Sedation, CAD/CAM, Advanced Prosthodontics those are three separate courses?

Louie Al-Faraje: We have those three, and we have the annual Fellowship, which is also a three-weeks program.

Howard Farran: A three-week-

Louie Al-Faraje: Totally we have around six weeks. Yes, so we have a Fellowship program, three sessions, full week each, six days again each. And then we have the Oral Sedation three-day course, and we have CAD/CAM five-day course, and we have Advanced Prosthodontics, five-day course.

Howard Farran: When you talk about oral sedation. What is the basic of oral sedation? Nitrous oxide and pharmacology?

Louie Al-Faraje: Yes. Oral sedation, the Halcion mainly, so that's a certification that we provide at the institute. I do not speak at that course, and we have live patient demonstration, that is mandatory to do. It is a certification course, so you can apply, or we apply for you and we get the oral sedation permit for you with this course.

Howard Farran: What is the five-day CAD/CAM on? Is that chair side milling for crown and bridge? Or restoring implants?

Louie Al-Faraje: Side chair milling for implant crown and bridge for a full day, but we walk you from the digital smile design, on day one, to a computer-guided implant treatment planning, to the surgical execution of implant placement, using computer-generated surgical stents. Then, two days of covering the lab portion, if you will, of implant restorations. Five days walking you through the digital workflow in implant dentistry, from smile design, to restoration fabrication, and delivery, but all using the CAD/CAM technology.

Howard Farran: What type of CAD/CAM milling machine do you recommend? Use? Teach with?

Louie Al-Faraje: Zirkonzahn, it's an Italian machine. I think it's the industry standard, and that's what we covered at the course.

Howard Farran: Spell it again.

Louie Al-Faraje: Zirkonzahn, so Z-I-R-

Howard Farran: Z-I-R.

Louie Al-Faraje: K-O-N-Z-A-N.

Howard Farran: Zirkonzan, and where are they out of?

Louie Al-Faraje: They're an Italian company, but they have many locations in the U.S.

Howard Farran: Is it large enough to mill complete zirconia All-On-4 round house?

Louie Al-Faraje: Yes, it is. Again, the spelling again is Z-I-R-K-O-N-Z-A-H-N, Zirkonzahn.

Howard Farran: I found it, I will inform my homies listening to this. They are on, they've got a Twitter button on their site, I'll retweet that so they don't have to remember. They are @Z-i-r-k-o-n-z-a-h-n-World. Yes, they are out of ... Do these uniforms look familiar? Some of you yes, it is, new time. What would be the ... I'll just retweet the last tweet. 

Tell us about that CAD/CAM because in America, I would say the number one selling brand CAD/CAM was Sirona, Dentsply Sirona, and probably number two was E4D Planmeca, but that was ... Do you kind of think that was for, mostly a smaller single unit crown, and the next generation in CAD/CAM will be more bridges and full arches?

Louie Al-Faraje: That's right. Zirkonzahn is affordable enough to have it in the office, to be owned by dentists, if you're doing maybe 10 to 15 cases a month. It is a higher level than what Sirona can do. Sirona is a great machine, but Zirkonzahn and the [inaudible 00:21:52] scanners usually are for bigger cases, and they do a better job than those who are designed for intra oral single, or small multi-unit span bridges.

Howard Farran: Nice. How much does that machine cost?

Louie Al-Faraje: They have different models, around hundred.

Howard Farran: 100,000?

Louie Al-Faraje: Yes.

Howard Farran: It can do everything really Sirona can do, and E4D, and more?

Louie Al-Faraje: Absolutely, it can do everything those machines can do, and more.

Howard Farran: Wow. I wish you'd make an online course for thatm too. I just think that would be amazing. Like okay, I've even heard of them before. Think about how many people in Dentaltown have never even heard of this. Any chance you make us an online course on just the CAD/CAM, too?

Louie Al-Faraje: Yes, absolutely I'd love to.

Howard Farran: Because you have so much free time now that you're not writing a textbook right now, you have 2,000 hours of free time 'cause you're not writing your fifth book.

Louie Al-Faraje: That's right.

Howard Farran: Oh my gosh, that is amazing. As far as your Advanced Prosthodontics course, most people say that implantology is really a prosthetics procedure with a small surgical component, it's all driven by the prosthesis. Do you agree with that?

Louie Al-Faraje: I do not agree with that.

Howard Farran: You do not agree with that.

Louie Al-Faraje: I do not agree with that. I think implant dentistry is exactly 50% a surgical component, and 50% a prostetic components. Because you design the prosthesis for the patient, but then, if the patient does not qualify because of his bone to what you're trying to accomplish. Then we're back to square one. 

My technique of doing treatment planning is to start with the CT scan. This is how we do the treatment planning, and this is how we teach to do comprehensive treatment planing. We start with the 3D CT scan to look for certain things, like the available height and width of [inaudible 00:24:13] bone for implant placement, bone density, certain anatomic landmarks, pathologies. Then we do clinical evaluation for the patient's smile, from how much he shows in size of display and repause in white smile, if we have gummy smile. What the skeletal classification of the patient, and how a surgery can influence the skeletal classification to go from maybe Class II or Class III, to as close as possible to Class I that is possible. Sometimes with a surgical intervention, when we are doing especially both arches. 

Then, we go back now to the CT scan, for more detailed evaluation, and to pinpoint the location of the implant so the configuration, maybe four or five tilted, for like All-On-4 or not. Then, the sizes, diameter and length of the implants. CT scan evaluation, clinical evaluation, and back for more detailed CT scan evaluation. Because when you do CT scan evaluation before clinical evaluation, you immediately will eliminate certain things. As not to spend too much time on them during the clinical evaluation, because you would know there's a few options the patient is already not a candidate for, even without seeing the patient simply by looking at the CT scan. Now after the clinical evaluation, we know what he's candidate for, and we confirm that with a CT scan one more time.

I mean, for example, if the patient already lost quite a bit of bone due to periodontitis, or edentulism, then obviously he's not candidate for crown and bridge, he's candidate now for hybrid hopefully, or implant and soft tissue supported prothesis. Now when you're doing a clinical evaluation, you already eliminated certain prostetic options that the patient can have, and that will be more ... you have less time and more accurate, and more thorough clinical evaluation. CT scan, clinical examination, and CT scan again for more detailed evaluations. We developed a certain protocol to save the doctor time, because you have to do free consultations these days. Patients are shopping around for implants, especially when the treatment is big and it's anywhere from 5,000 to 30,000 per arch. We have certain protocol that we developed to enable the dentists do very thorough clinical evaluation in very short time, because again, you're not getting paid for the free consultation time.

Howard Farran: I like that. What CT scan do you use? What do you recommend if someone asked you?

Louie Al-Faraje: For implant dentistry most CT scans, machines do well. Some of them are not too friendly, their software is not too friendly, But quality-wise, and the image size-wise, most CT scans are just fine for what we need. I like the i-CAT, and I like PreXion. I like those two machines. However, there is a few others that will do just fine for implant surgery.

Howard Farran: You're involved with Novadontics?

Louie Al-Faraje: Yes.

Howard Farran: Explain what Novadontics is.

Louie Al-Faraje: I started Novadontoics a few months ago, it's a new company. The goal is to help doctors to perform predictable implant dentistry on one side. On the other side, help them to save quite a bit of money on the overhead because we use the collective power, if you will, of Novadontics smile providers to have a very good discounts.

Part the idea of Novadontics started from aviation. In the aviation world, we have a very high margin of safety, and the secret is because pilots use checklists. Unfortunately, in many other professions there's no checklists. There's no checklist culture, and accordingly the results are not a successful outcome of what the other professions do, not as high as it is in aviation. 

I was reading once in an article, in aviation magazine and I told doctors about this, when we talk about the importance of checklist. In the article it said that if we have in the U.S., if the airline industry in the U.S. is 99.9% safe, we will get four crashes a day. Not a week.

Howard Farran: Wow.

Louie Al-Faraje: Nobody will step a foot in an airline that has only 99.9% safety margin. Obviously, the safety margin is way beyond 99.9%. Just consider for a second, the airline industry did not have any crashes in seven years. They brought the protocol to extreme science. The secret is not pilots are smarter than doctors, or engineers, or any other professions. They simply follow a checklist. While you do not need a checklist in dentistry when you're doing a crown and bridge, or a filling. However, in implant dentistry is a different story, especially if the case is big. You have a multi-unit case, or full arch case, there is roughly 200 check points that you have to do in order not to over look any detail as you are doing diagnostic for the patient diagnostic work.

We have an App called Novadontics Smile App. When you join Novadontics, as a dentist, you become a Novadontics smile provider. Think of this as Invisalign, meaning you offer Invisalign in your office, you have a brochure about Invisalign. You can be a Novadontics smile provider and you will ... The Novadontics smile procedure is for patients who are fully edentulist, or about to come fully edentulist because of a terminal dentition that they have. It is very predictable, very safe way to perform full arch implant therapy. From the surgical, to the prosthetic aspect, and if doctors are interested, they can go to Novadontics.com. There is a link at the bottom of the page become a Novadontics provider, for more information on this.

It uses the very sophisticated electronic checklist that will give you all the options to choose from. I think you will do the job like a pro with very little experience. Of course, Novadontics is a complete ecosystem, because the California Implant Institute will make sure through certain courses that you are performing the full arch implant reconstruction very safely and in very predictable manner.

Many implant company providers are on board. We use exclusively Nobel Biocare implants, and a Geistlich bone grafting products, Piezosurgery products. Omnia instruments and disposables. We use only the highest, absolute highest quality products, proven products available in the market. Highest training. We have the proprietary, if you will, method of combining the CT scan with our checklist protocol, to do as predictable as precise implant therapy as possible for our patients.

Howard Farran: You mentioned for a CB/CT that you like i-CAT and PreXion. I retweeted i-CAT's last tweet, but PreXion hasn't tweeted since 2014, three years. When I go to any of their tweets, and their links, all the links are dead. I wonder if PreXion is still alive and kicking, or what's going on, do you know?

Louie Al-Faraje: Very high quality, I love their software. They have been doing through restructuring I know recently, maybe that's why some links are broken. It's a terrific machine.

Howard Farran: Yeah, I can't find any tweets. Oh, yeah, I can't find any tweets that are working. I did retweet I-CAT, they are basically @iCAT3D. The question that all these kids are asking what implant system do you use? It's very confusing when you walk out of dental school and you go to the ADA convention, and you see literally 175 different implant companies telling you theirs is the best.

Is this true or false? Tiger Woods could beat you and I in golf playing with any set of clubs? Or do you think the clubs have a lot to do with the success? Are there a lot of implant systems that are fine? Or do you have a particular favorite? Which one do you teach in your institute?

Louie Al-Faraje: I do have a favorite, Nobel Biocare. I grew up with Nobel Biocare. There is many other systems that they do just fine. However, my favorite is Nobel Biocare for many reasons. Reason number one, they have the biggest prostetic options for components to restore implants, they have the best service, and they've been around for long time, so it's a proven product. Their components do fit very well, so service is very important. Of course, you can find cheaper implants. You have the cheap implants from [inaudible 00:35:48] Korean, but then you have the higher class implants, the European, or the American like Zimmer, for example. My favorite is Nobel Biocare, but I do like a couple of other companies that I used in the past. Again the best service you will get from Nobel Biocare, and the biggest prostetic selection is from Nobel Biocare. Very innovative, they always improve their products, and they are the industry standard, an industry leader. They are the king, and I like to deal with kings.

Howard Farran: Okay, again, I recommend that you read textbooks. You've written four textbooks. I can't think of a faster, easier, higher quality, lower cost way to learn endodontics than reading the new Stephen Cohen, Pathways of the Pulp, I think it's like Seventh Edition. I can't think of any faster ways than textbooks. Right now, we're talking to mostly 30 and under. The 30 and under crowd is trying to do their first implant. The 40 and 50 and older guys, like my buddies that do All-On-4, all over them are over 50. I don't know anyone under 50 doing an All-On-4. Have you had many students in your class, on the All-On-4 class that were under 50?

Louie Al-Faraje: Yes, yes. We've been getting more and more and more, younger dentists who are getting into implant dentistry. There is advantage to start implant dentistry as soon as possible, after graduation. After getting dental degree, because you don't have to shift from the crown and bridge mentality into implant dentistry. I noticed that it's good to have some experience, but at the same time, when you start implant dentistry right after school, there is also quite a bit of advantage for that. Doctors are very bright, young dentists graduating these days, very motivated and very bright and I'm very impressed with almost all of them. As I said, we've been getting the younger and younger crowd every year.

Howard Farran: When you say younger, you mean 41, 42? I mean I'm 54.

Louie Al-Faraje: Younger, I mean graduated two months ago from dental school.

Howard Farran: In their twenties?

Louie Al-Faraje: In their twenties, they're taking implant courses, they're getting into the surgical phase of implant dentistry, and they are doing fantastic.

Howard Farran: True, true, I agree with that, but I'm talking about specifically your All-On-4 case, what's the youngest student you've had take the All-On-4?

Louie Al-Faraje: Any doctor who has around 100 implants under belt, definitely more than qualified to start offering and learning the full mouth reconstruction. All-On-4 is only one of the variations of full mouth reconstruction using dental implants. Anybody with roughly 100 implant experience can definitely start the journey into learning how to do the full mouth implant reconstruction. 

In a way, you require more knowledge, but skills-wise it, you need less skills to do full arch than to do single implant in the aesthetic zone. You are starting with a new slate, like they say, and you can dictate the shape, the shade, the occlusion. You have more control over stuff when you do a prothesis, like a hybrid you have even control over the soft tissue look because you have all those perfect [inaudible 00:39:47] fabricated with the prothesis.

In a way it's easier, and less skills required but it requires more knowledge, of course, to do a full arch. There's no bone grafting involved, so definitely young dentists can get into implant dentistry and definitely with less experience than you can think, you might think, they will be qualified to start learning and offering and performing full arch implant reconstruction.

Howard Farran: That is a huge advantage of All-On-4, you don't have to do a sinus lifts and bone grafting, right?

Louie Al-Faraje: Exactly. It's called the graft less solution for patients who are [inaudible 00:40:30], of course. Those patients who are candidate for this procedure, they can greatly benefit from it. Again, I would like to mention here Nobel Biocare, because they are the one who started this movement, if you will, and their components are the best for All-On-4. Even if doctors are happy with another system, I [inaudible 00:40:49], keep it but for the All-On-4 definitely I want to use a Nobel Biocare components. We have been getting great results, and much less complications if any, with the prostetic components for the All-On-4 from Nobel Biocare.

Howard Farran: Now, it was invented, wasn't it by Dr. Paulo Malo out of Lisbon, Portugal?

Louie Al-Faraje: I'm not sure, if he's the one who started it. In biomechanics books from the '80s, before I think he became a dentist, we had already lots of sketches showing the [inaudible 00:41:29], if you will, of the All-On-4 concept, of tilted implants up to 30 degrees, in multi-unit cases. Scaliac from San Diego, he wasn't a dentist, but I don't know if you heard of him. He was a bio mechanic guy. He has all kind of studies proving the concept of All-On-4.

Howard Farran: The biggest argument against All-On-4 is you hear people say, "All-On-4 is None-On-3." What do you say to that argument that All-On-4, if you lose one of the four, you lose the full arch, so it's All-On-4, None-On-3. What would you say to that? You've heard people say that before, haven't you?

Louie Al-Faraje: That's right. Of course, you would have to remove the prothesis, and you would have to bone graft the area and do another implant to replace the one lost, and do a new prothesis. If things are done right, that chance is extremely small. That's why we try to keep, for example, after the All-On-4 the patient on the temporary fixed prothesis for as long as possible, so at least six months, hopefully, to make sure implants are so integrated, no problems with them whatsoever.

Now, we move to the fabricating the definitive prothesis for the patient. I mean, you can put All-On-5, and None-On-3, you can do All-On-6, and None-On-3, so this is not very valid point because if you do implants for the patient who is candidate, and if the prothesis done right, if the biomechanics occlusion, in particular is also done right for the All-On-4 patients, or full arch immediate loading patients.

Howard Farran: One of the neat things I love about dentists is, most of them when you survey, say when you want to know more about a product what do you want? 91% of dentists say they want to talk to their peers, only 9% say they want to talk to the company. When I search, I have a search on Dentaltown, so we've got a quarter million dentists, they've posted five million times. When I type in your name Louis Al-Faraje, my gosh, it's just nothing but praises about you, the California. Some guys says, "Has anyone had any recent experiences with this California Implant Institute?" Anyone know anything about you? The next guy says, "Dr. Louie is very knowledgeable, informative, inclusive, I feel like I made the right choice to take his classes. Best of all, many of the dentists attending the classes who have taken implant courses somewhere else are finding answers to many questions left unanswered from other classes they have taken in the past. I highly recommend The California Institute and Dr. Louis Al-Faraje to every desist desires to gain valuable knowledge." Blah, blah, blah, blah, blah.

I mean, you are mentioned in several threads. That's a neat thing to do for your dentists. Let's say you have a bonding agent and you're not sure if you're having problems because you have the wrong bonding agent, or you don't know how to use it right. All you've gotta do is go onto Dentaltown, and hit search, type in your bonding agent, type in whatever question you have, and it's already been asked a thousand times because when you have a quarter million dentists who have posted five million times, I mean, there's not many questions that are left to be asked. I just wanna tell you that your townies love you.

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