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VIDEO - DUwHF #905 - Omid Termechi & Cory Glenn
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AUDIO - DUwHF #905 - Omid Termechi & Cory Glenn
Dr. Omid Termechi
Dr. Omid Termechi is a leading practitioner, educator and innovator in implant dentistry. With offices in Astoria and Long Island, he provides the full range of general, implant and cosmetic dentistry services. Both offices are equipped with state-of-the-art dental chairs and technology such as low-radiation X-Rays and 3D CT scanners. Using minimally invasive pain-free procedures, Dr. Termechi restores smiles and works closely with his patients to help them maintain their dental health.
Dr. Termechi received his D.D.S from the New York University College of Dentistry in 1998. He completed General Practice Residency programs at the Interfaith Medical Center and at the Kingsbrook Jewish Medical Center, both in Brooklyn, NY. He also completed a two-year, full-time Fellowship in Oral Implantology and Biomaterials at the Brookdale Hospital Medical Center in Brooklyn, NY.
Dr. Termechi is an Attending at the Brookdale Hospital Medical Center, Department of Oral Implantology and Biomaterials. He is an Assistant Professor at the Implant Department of New York University College of Dentistry. He was an ADA CELL Seminar Series Lecturer from 2005 to 2015.
Dr. Termechi has achieved an Associate Fellowship status in The American Academy of Implant Dentistry (AAID) as well as Fellowship and a Diplomate status in the International Congress of Oral Implantology (ICOI).
In 2017, Dr. Termechi founded the Dental Implant Surgical Seminar (DISS) in partnership with Universidad Francisco Marroquin (UFM) School of Dentistry in Guatemala. DISS helps general and restorative dentists expand their private practice into implant surgery.
Dr. Cory Glenn
Dr. Glenn graduated from University of Tennessee Health Science Center College of Dentistry. Following graduation, he completed the Lutheran Medical Center’s advanced program in general dentistry at the UT Memphis branch. He is a graduate of the Georgia Maxi Course in Implant Dentistry, the American Orthodontic Society’s Comprehensive Ortho Program, and is credentialed as an Associate Fellow in the American Academy of Implant Dentistry.
He has served as the CE director for the TN AGD and as president and CE director of the Middle TN Dental Study Club. Dr. Glenn is also one of the founders of Blue Sky Bio Academy, the online learning center. For several years, Dr. Glenn ran a private practice in Winchester, TN where he performed all disciplines of dentistry with a particular focus on utilizing technology and innovative techniques to provide treatment in an efficient and cost-effective manner.
Dr. Glenn is the VP of Technology for Blue Sky Bio, the leading innovator in implant technology, where he focuses on product and software development as well as clinical customer support. He speaks extensively about CAD/CAM, cone beam technology, guided dental implants, dental photography, digital smile design, complete dentures, and complex full-mouth rehabilitation.
Howard: It is just a huge honor for me to be podcast interviewing Dr. Omid Termechi all the way from Long Island and Dr. Cory Glenn all the way from the beautiful metropolis of Winchester, Tennessee. How are you guys doing today?
Cory: Pretty good, man. How are you?
Omid: Good, thank you.
Howard: Well, I want to tell you that this is such an honor for me that I'm podcast interviewing you in the middle of the Arizona Cardinals, my life passion as they're playing the Tennessee Titans. So Cory, how come you from Tennessee and me from Phoenix, how the hell did we schedule this podcast in the middle of the damn game?
Cory: Oh, yeah. I have no idea. And right in time for deer season too. (Inaudible 00:00:44).
Howard: Well, so Omid is a leading practitioner, educator, innovator in implant dentistry with offices in Astoria and Long Island. He provides the full range of general implant and cosmetic dentistry services. Both offices are equipped with state of the art dental chairs and technology such as low radiation X-rays and 3D CT scanners using minimally invasive pain free procedures. Dr. Termechi restores smiles and works closely with his patients to help them maintain their dental health. He received his DDS from New York University College of Dentistry. Now is that NYU?
Howard: Yes, 7% of all the practicing dentists in America graduated from NYU. That is a huge monster school. He completed general practice in residency programs at the Interfaith Medical Center and at the Kingsbrook Jewish Medical Center both in Brooklyn. He also completed a two year full time Fellowship in Oral Implantology and Biomaterials at the Brookdale Hospital Medical Center in Brooklyn. Dr. Termechi is an attending at the Brookdale Hospital Medical Center Department of Oral Implantology and Biomaterials. He is an Assistant Professor at the Implant Department at NYU College of Dentistry. He was an ADA CELL Seminar Series lecturer from 2005 to 2015.
He has achieved an Associate Fellowship status at the American Academy of Implant Dentistry as well as fellowship and diplomat status in the International Congress of Oral Implantology. In 2017 he founded the Dental Implant Surgical Center otherwise known as DISS, D-I-S-S, Dental Implant Surgical Center in partnership with Universidad Francisco Marroquin, UFM School of Dentistry in Guatemala. This helps general dentists and restorative dentists expand their private practice into implant dentistry.
Cory Glenn who I assume needs zero introduction since he has the most views of anyone – we put up 400 online CE courses. You're always our most viewed, you're always our most popular. He graduated from the University of Tennessee Health Science Center College of Dentistry. Following graduation he completed the Lutheran Medical Center's Advance Program in general dentistry at the UT, Memphis branch. He is a graduate of the Georgia Maxi Course in Implant Dentistry, the American Orthodontics Society's comprehensive Ortho Program and is credentialed as an Associate Fellow in the American Academy of Implant Dentistry.
He has served as a CE director for the Tennessee AGD and is president and CE director of the Middle Tennessee Dental Study Club. Dr. Glenn is also one of the founders of Blue Sky Bio Academy, the online learning center. For several years. Dr. Glenn ran a private practice in Winchester Tennessee where he performed all disciplines of dentistry with a particular focus on using, utilizing technology and innovative techniques to provide treatment in an efficient and cost effective manner.
Dr. Glenn is the vice president of technology for Blue Sky Bio, the leading innovator of implant technology where he focuses on product and software development as well as clinical customer support. He speaks extensively about CAD/ CAM cone beam technology, guided dental implants, dental photography digital smile, complete dentures and complex full-mouth rehabilitation. But Cory, I know my homies. I've been on Dentaltown four, five hours a day since 1998 and you know why you're so loved on Dentaltown?
Cory: Why is that? Like the looks?
Howard: Well, you're good looking and handsome, no doubt about it. But it's the fact that – I remember when I got out of school and it seems like the whole lecture circuit was focused on lifestyles of the rich and famous, dentistry on elite rich people, models and Beverly Hills. I remember going to The Pankey Institute, just young kids straight out of school. I went through all five weeks but I didn't like it. I mean I went there and the first thing he does is starts talking about the A patient, the B patient, the C. And when he starts explaining the C, D and F patients, that was the entire Farran family tree. And what I love about you is that everybody needs a dentist. And you always keep one eye on the patient, one eye on cost and you use your God-given talent to drive down costs so your patient can afford to have treatment.
And when I go to a CE lecture I don't give a shit about how you treat movie stars with $50,000 cases because that ain't my world. You hear me, I'm across the street from the Guadalupe Indian reservation that has 5,000 legal citizens and 10,000 illegal citizens and they're pushing weed eaters and lawnmowers for – and hammer and nails for 20 bucks an hour cash and you always – I mean you could squeeze a quarter out of a lemon. I mean, how do you do it? Don't you agree with what I just said?
Cory: Yeah. That's kind of been borne out of this situation of practicing because I love doing all that fancy stuff you mentioned but no one can afford it and so it's – just figure out how I was going to do that stuff. I had to figure out a way to do it cost effectively. So I almost get as much enjoyment out of figuring out those ways as I do with the actual treatment itself.
Howard: And it's the same thing with that with PPO dentistry. I mean when I got out of school Delta paid me – I mean I submitted my fee to Delta, it's a thousand bucks. They paid half. Now they submit me the fee and it's 600.
So all that means is you got to go 40% faster. You still see these dentists my age that their whole career, they schedule an hour and a half for a crown. It's like dude, does it really take an hour and a half? I mean they'll go numb and then they'll go sit in the office and then they'll come back in prep, then they leave. They have an assistant, spent 15 minutes (Inaudible 00:06:20). Then they go back and impress (phonetic 00:06:22), then they leave. Then she'll take 30 minutes to do a temporary. Then you go, okay, and his overhead is 65%, 70%.
Then you go cross the street, dial schedule a half hour. You'll go in there numb? with septocaine. He'll assign her four minutes and then he'll take the shade to the lab script. Four minutes. Ding. He'll pack the one cord, the zero cord, the one cord, then he'll prep. Then he'll make the temporary with his assistant and that's a great way to check your margins, your occlusion, your clearance so you don't get a reduction (Inaudible 00:06:51). Then they'll take that optic and impression. Go to your hygiene check.
Come back, check the impression, cement the temporary. Boom, 30 minutes. Thirty minutes – I mean – so we are doing a $600 PPO crown and you can do three of them in an hour and a half. That's 1800 bucks.
So, I just love the way your mind works, your mind. You always increase quality while reducing costs. That's the only thing everybody associates with Cory, just faster, easier, higher quality, lower cost. So what's got you guys passionate today. Tell me about this.
Omid: So this is a program that I felt and I was very passionate about creating and the way it actually became and it came about was I teach in NYU one day a week on Wednesdays in the Perio and Implant Department. And one of my old student who graduated from the program four years ago –– we basically teach international students in NYU and we have 16 international students per year and we have two year program that they come from different countries and they spend two years learning simply dental implant surgery and everything that goes with it.
So I've been part of that since 2006. And during which I met a lot of people who are foreigners from different countries. They come here for two years. They spend time and then some of them they actually go and they become specialists in Perio or Pros or whatnot in NYU. But one of my old students who graduated five years ago, he's from Guatemala and they have a fantastic beautiful, high-end, great technology, state of the art university over there, Francisco Marroquin. And he is now the director of the implant program in that university. It's basically a dental school. They provide all types of services, dentistry to the population over there. And I just happen to...
Howard: Is it in the capital?
Omid: Yes. This is in Guatemala's – (Inaudible 00:09:05) which is the capital of Guatemala. And I have been going there for the past two summers. One of the things that the university does, they basically want to attract more students from Central America and South America to their university. And one of the things, programmes that they did, annually they do have one meeting that all the Central and South American countries get together. And they did a live broadcast of a different surgery the past few years. I did a science graph and an immediate implant placed in the first year and then I did the autogenous block graft using the ramus to put on the anterior in the premaxillary area. And that was live broadcasted.
So after these two events that I went back to back two summers, I see that there is a great potential over there. The facility is fantastic, they have a room. They teach over there so it was kind of a no brainer. I decided that it's not a bad idea to create another program where you could basically teach general practitioners.
Today I keep up with an idea of creating a program that we can teach practitioners who don't have any dental implant surgical training to be able to go ahead and learn how to do implants on a basic level. To be able to recognize the patient, to have the tool, to give them the tool that they can recognize the patient and be able to go and perform, one, two, three implants, maybe all the denture cases in one app so they can go ahead and get clear with it.
Because I was just reading an article from AID and that was published in 2006. It says, back in 2006, 5.5 million implants were placed in the United States and 3.2, of it was placed by a general practitioner. So now that the general...
Howard: Say those numbers again.
Omid: 5.5 million implants were placed in 2006 in the United States and 3.1 point something of it was placed by a general practitioner. Not that general practitioners are obviously placing more implants than specialists but there are certainly more general practitioners so therefore naturally...
Howard: Did this break out the oral surgeons and the periodontists or just lumped them into specialists?
Omid: No, no, no. That number just includes the general practitioners who place implants in the United States.
Howard: If you got a source on that can you email that to me, Howard@dentaltown.com?
Omid: Absolutely, absolutely. So that's basically, as you know, and our program is – obviously we included Cory in this because I recognize that technology is extremely important to people. We want to give them the tool that they can actually be comfortable to place the implant properly. We want to teach them a correct placement versus somebody who takes, let's say, just a over-weekend course and didactically they learn about the implant and they have some surgical skills and they want to go ahead and do it.
We want to take it from that level of really don't know anything and that in four day period to be able to go ahead and learn didactic and give them the computer-guided surgery advancement and teach them that and for them to be able to go ahead and place the implant just like a pro does. Because once you are able to go ahead and plant it and be able to take it out of the computer and put it on the cast and in the model and naturally on the patient, they're going to be able to do a good job.
Howard: So Cory, what's your part in all this?
Cory: Yes. So there's really three reasons that I'm involved with this. First of all, I'm working for Blue Sky Bio now. One of the things that we – we're a laying company so we do everything web based. That's how we keep our costs down and one of the places we've been lacking is in live surgical training. So historically we've been a company that if you needed a rep to come in and hold your hand and help you to pick parts and all that we're worth your company, right? We were good once you knew what you were doing. But we've been lacking in that respect. So I wanted us to be able to have something where we can take a dentist that knows absolutely nothing about implants and get them surgically competent to place and do it all under our umbrella.
And so that's the first thing. We didn't have many clinical courses like that and the DISS group is providing that where they can take a general dentist from zero to competently placing through that four days. Secondly, if I was going to be part of that, there was a couple of things I wanted it to do. One, I didn't want to be a deal where you go to one of these courses out of country and they slam home a bunch of implants. You have no idea if they integrate. Half the country is walking around with unrestored implants because they're just human guinea pigs.
That's always rubbed me a little bit the wrong way and I know there's some hands on out of the country surgical courses that way. So I like the aspect of this one that it's in a university setting. The patients are getting followed up. They're getting restored and getting restored at a really high level. And then the other aspect, obviously I'm a big technology guy. I really feel like guided is the way to do it. Not that you can't do it well without guided surgery but why would you want to if it makes things – for me at least, so much more predictable and being able to do all of our surgeries through this course guided and help the attendees grasp that. I think it lowers the risk on the people starting out with their placement and I think they get a better overall result.
And so if I'm starting out I want to learn it that way from the very start and not have to go through this really steep learning curve, a free hand surgery where the first two years you screw up every implant that's not on your dominant side like I did. I just thank God it is going to make this so much more efficient. So all of those things meshed up with what Omid is talking about and he contacted me and I was glad to jump on board with it.
Howard: So basically, I know you have a friend in Guatemala, all that, but basically you want to go to Guatemala just to lawyers because if someone came from Arizona to New York City they wouldn't be legally hands-on, so is that correct? Is that why you're going out of the country?
Omid: So, of course that definitely is the case. And the question really becomes, where in the country are you going to be able to find, then you could go ahead and take in people and find 150 implants that you could go ahead and place and people are willing to go ahead and come in because you're giving them a fantastic price. Plus, I have to say, the people over there do pay. The only thing they don't pay is the surgical aspect of it. They do pay the university for restorative aspect of it. We have five restorative residents. There are five cross residents in the university that they're going to go ahead and restore these implants.
Now one of the things that we also give to our participants is a full credit of our course towards fellowship of the ICOI. Now, I want the residents to be able to be in contact with any of the participants that we have. And for them to be able to go ahead and see their follow-up cases to be completed once it's completed. If they stay in touch with the resident, they'll be able to go ahead and see the X-ray when it's final, when it's finished, when it's in the patient's mouth so they can go ahead and do that. The other thing is that university takes full credit of possibly any failure that can come from this. They are there to go ahead and secure those failures and to be able to go ahead and replace those failures.
We all want our patients to be – again, one of my first slides for the course is to be respectful to the patients and treat it just like they are in your own practice. We don't want anything as far as patients walking around with that implant, with our implants in their mouth and not being restored. We want to be able to go ahead and finalize all the cases and be able to teach our participants a proper implant placement. And that's really our goal. And people in Guatemala are paying for restorative part of this. So they're basically getting 50% discount on the university price on any implant from beginning to the end.
Howard: So have you guys both been down there yet, to the dental school?
Omid: So I've been down there. Cory has joined us after I decided because this is the new DISS. This is my new thought and my new creation. And Cory hasn't been there but our next meeting where Cory is going to be there is going to be on February 19th to 22nd. And that's when we are there when everybody's freezing here in the United States.
Howard: Oh my God.
Omid: At least we're (Inaudible 00:18:17).
Howard: You got it. You got to get me a free speaking gig at the dental school to their students. I love Guatemala. I mean gosh that country touches – Mexico, Belize, both oceans, Atlantic and Pacific, Honduras, El Salvador. I mean Cory, I swear if you go there from Winchester Tennessee and you go down there and hang out in Guatemala for four days you're probably going to apply for citizenship. I mean there is no way in the world you won't fall in love with Guatemala.
Cory: I'm actually flying there from your other favorite place, Sydney, Australia.
Howard: Oh, that's where my brother lives.
Omid: I'll be in Sydney teaching and then I'm flying straight to Guatemala for that course. So that's going to be jam packed day.
Howard: So what's your flight, Sydney to LA, then Guatemala City?
Cory: I have no idea,it's all over the place.
Howard: My God, and let's say, people don't respect how grueling a speaker's job – I mean like when I lecture in India it's five hours in New York, 15 in New Delhi. Lecture to 250, turn around and go back home. Sydney, one hour to LA, 16 hours to Sydney, lecture, turnaround and six – oh my God, I feel like I've been a plane rat. And I remember that (Inaudible 00:19:36), oh my gosh. So that's just brutal. I'm already hurting for you and you have them back problems so hopefully...
Cory: Yeah. I have to take a lot of medicine to get through those flights. So it's a (Inaudible 00:19:49). But I have – not a bad deal once you get there so I'll suck it up.
Howard: Yeah. Well man, Guatemala City, I just love that place. So let's start with day one. I was asked by homies and do this if you're listening. Shoot me an email, Howard@dentaltown.com. Tell me who you are, how old you are, what's going on, who you want to have on the show. 25% of them are still in dental school and the other 75% are 30 and under. So they're coming out of school. This is why I want to – they're coming out of school and they all say the same thing. I graduated $250,000 in debt. I didn't place one implant. So you're speaking to her very clearly, someone who doesn't know anything about implants. Go from zero to one in four hundred and in four days in Guatemala City. But she tells me all the time that she almost feels like she has to pick the implant first because most of the training available to her is implant company sponsored. So would you recommend that she start with Blue Sky implants?
Omid: So, I'll answer and if Cory wants to jump in. So one of the things I can tell you, obviously we have sponsorship from Blue Sky Bio but I personally have (Inaudible 00:21:10) Blue Sky Bio many, many years now.
The beauty of Blue Sky Bio, one thing I have to say, is the fact that, if I am a Zimmer user, I can use Blue Sky Bio. If I'm a Straumann user, I can use Blue Sky Bio. If I'm an Astra user I can – I found a Nobel user I can use Blue Sky Bio. So it doesn't matter what type of implant you prefer in your practice or you like to go ahead and place. And the reality one of the things that I suggest is when you are deciding on an implant in your practice there are certain criteria that has to go with that. What are the top criteria that I have for general practitioners who want to get involved in implant dentistry is to place an implant that is easily restorable. It's economically sound and easily restorable. If you want to go anyplace and that's an implant you should go ahead and bring to your practice.
So that's what I would say, you're right it's a Blue Sky Bio sponsor implant. But Blue Sky Bio give you very versatile different type of implant system that you are able to go ahead and do either hexed up or internal hex or (Inaudible 00:22:24) or – whatever type you want we are able to go ahead and actually provide that to you. But we're not there to go ahead and say only Blue Sky Bio. There are some people who are coming in that already have implants in their practice that are already placing implants. We're not trying to go ahead and tell them to change.
They're going to place it at Blue Sky Bio implants in our program and then they can decide on their own if they don't want to go ahead and stay with Blue Sky Bio or they want to go back to what they have in their own practices.
Howard:What are your thoughts Cory?
Cory: Yeah. I mean obviously with being with Blue Sky Bio sponsoring this course that is a big part. I think our implants are great. I don't think anyone else is any great. I'm just kidding. But we do want them to experience our products. We think we've got a ton to offer. But the biggest driver behind this course is the guided surgery aspect. And so I know for a fact that everyone's got pretty good implants for the most part. No one can touch us as far as the digital. The guided surgery and being able to do it affordably, that to me is the biggest thing that Blue Sky Bio can offer.
And that's what we want them exposed to and to appreciate. And then I think if you get that the implant stuff logically follows after that. And going back to how you started this whole thing about you've got insurance driving costs down, you've got patients in a lot of areas they can't afford really expensive treatment. If you're starting off with a $400 to $600 implant and then the abutment it's going to be another 300 and then you're going to send off $400 crown. There's just no – there's nothing left at the end of that with what you could actually charge in my neck of the woods
And so that's a big reason why I've used Blue Sky now for quite some time even before they knew who I was or before I worked for them was because their business model enables me to deliver a good high quality product at an affordable price and I pass those savings along.
Howard: So we podcast interviewed the founder of Blue Sky Bio, Sheldon Lerner, DMD. Did I say his name right, Lerner?
Howard: Lerner. Yeah he was podcast number 89. I like that guy. Are you still working – are you working with him closely on this?
Cory: Oh yeah. I speak with Sheldon daily.
Howard: Daily. Well tell him I said I hi. He was our podcast number 89 and now we're at 950. Tell him that he had to come back on the show or better yet tell him I want a podcast interview him live in Guatemala City.
Howard: At your course. That would be (Inaudible 00:24:59).
Omid: That would be great. That is very good.
Howard: And we'll do it really early in the morning before we start drinking. And so – but yeah, I love I love Sheldon. I mean I think he's a great guy and he's great company. And by the way FYI, these are never commercials. No one's ever paid me a dime to be on my show. I don't get a dime for bringing these guys on this. I just talk to people. I just like to find townies that are passionate. So I got another question. This little girl that just come out of school, she's 25, she's $250,000 in debt. She said, I didn't place an implant. I didn't do any Ortho. I didn't do any Invisalign. I didn't do any sleep apnea and she's overwhelmed about all these things. She sees all these courses at the Pankey Institute, the Scottsdale Center, the Spear, Kois, Ross, Nash, all those stuff like that. But don't forget she's got her eye on $250,000 of student loans. Do you think implants are a great return on investment and if your daughter just walked out of school $250000 in debt and is going to open up in Winchester Tennessee, what would you tell her? What new skills out of dental school would you tell her to learn so she can pay off a quarter million dollars in student loan debt?
Cory: Okay. So I was one of those people coming out with that much debt. And obviously it's gone pretty well. Implants in my practice started a little slow and then every single year – it really doubled every single year and so we're placing over a hundred. So for me I think it's a no brainer. What's the absolute first thing you should do out of school. I think that's always your root canals, your extractions, your bread and butter.
It always cracks me up when I say this in my courses that dentists come out and the first thing that they want to do is go pay $60,000 to Frank Spear, John Kois and learn full-mouth rehab when they're going to do one full-mouth rehab four years from now. And that's probably the last one that they're ever going to do. Those are amazing courses and they're awesome. And there is a time in your career when that's probably excellent but that's not going to be your day to day, that's not going to be what pays the bills. Your Root canals, your extractions, your dentures. Why would you go learn full-mouth rehab when you can do the ultimate full-mouth rehab in dentures all day long every day. Everyone else prefer the mouth. Get efficient at that. And then everything else in dentistry bills on dentures. And then the implants is a big part of that as well.
Patients have missing teeth. They don't want a partial. So how are you going to help them with that? Are you going to send them off to the specialist who will probably charge them three times what you could do it for. It just doesn't make sense to me. So implants is a big journey. You can certainly get in over your head very quickly but placing a routine implant is not rocket science. I mean most dentists can learn to do this and the research we've done shows that if a dentist is competent and comfortable in doing a surgical extraction then they will press through and do dental implants. Because you see a lot of these people they go for it then they never place one. Kind of howI did with Ortho. The difference is if that doctor is someone who will do a surgical extraction and is not afraid to remove a little bone they'll do implants too. It's not going to be a problem.
Howard: Yeah. And a lot of them, so many, and I mean they say to me like, well I don't really like Molar Endo. I don't give a shit if you like it or not, man. You decide to be a dentist you're $250,000 in debt. Suck it up buttercup. I don't want to eat your snowflake bullshit that you don't like Molar Endo. And you know why you don't like Molar Endo? Because you're horrible at it. After you do 100 Molar Endos and get good at it, it actually turns fun. So much of life is an attitude. And back to your denture, girl, I still think that the people who took implants the farthest did it with dentures and a bait and switch. And same thing with an extraction and a bait and switch, what's that large denture clinic that has the affordable dentures, has like 100 locations?
You know what they do? They go into every market and they find what every general dentist charges for a single tooth extraction and they go 20 bucks under the lowest and all they advertise is like an $89 extraction. Well, who the hell comes in your office needing an $89 extraction, doesn't have a world of work to do? So they pull that $89 extraction and they get a chance to present to you a ton of dentistry.
And the same thing with dentures. The guys I know that just blew it out of the water, same thing, they'll do a bait and switch denture. They'll get good at dentures and they'll have the lowest-cost denture. But when you come in there they have the low-cost denture maybe full-mouth 450 and then nicer teeth from (Inaudible 00:29:47) maybe 650. And then the nicest one maybe a thousand and then a denture on two implants for 5000, a denture on four. So they advertise that low cost implant or low cost denture and I know people that when I got my fellowship diplomat and the International Congress for Implantology couple of my classmates went and bought a denture clinic that wasn't even owned by a dentist. It was owned by a denturist and they were doing like 300,000 a year.
And everybody in the county knew denture world was the place to go. And they took that place from doing 300,000 a year to 3 million a year because they could convert some of these to denture on two, denture on four or all on four.
Cory: Absolutely. I mean that's – your denture patients are primed and ready. I mean you never talked to a denture patient that's happy with their situation. So yeah, you've got a patient that is primed and ready for implants right there. So I think – dentists are insane if they are sending dentures out the door. They ought to be doing every one of them that they can if for nothing else just for practice because you'll learn so much about where teeth go in the mouth and vertical dimension. All these full-mouth rehab things you were going to spend $60,000 on you can learn in your practice and maybe don't pay you $14 for that denture.
And then you've got a patient that's primed and ready for actually getting implants and so Omid does this all day long at their program. This is a big part of what we're trying to teach dentists to do down at the DISS course is to be able to take those patients from either missing tooth here and there or just pull them out (Inaudible 00:31:24) and to be able to stabilize their dentures or to replace that missing tooth and typically to change the patient's life.
Howard: So your website is dentalimplantsurgicalseminar.com. Omid, what are my homies going to find if they go to – could you get DISS.com? Did you try to get DISS.com?
Omid: I tried. That was taken, unfortunately. And the reality is I wanted to go with the name that you could actually say the name and recognize exactly what it is. I want to tell you what it is without you even looking at the website to get a clear version of what we're trying to do. So it's about implants, it's about surgery, it's a seminar that you place an implant and so on and so forth.
Howard: So what are they going to find if they go to dentalimplantsurgicalseminar.com?
Omid: So basically what we are trying to go ahead and give them – we tell them the benefit of what we do, what we give them as far as when they come to our course, what they should expect to learn – the university, we have to get them a temporary license.
Howard: That is an adorable photo of you by the way (Inaudible 00:32:39)) that. I love that. You're like literally GQ, buddy, you could be on the cover of GQ wearing your DISS hat. That's a cool picture. But anyway, it's good.
Omid: Thank you. So based on this it's what we offer them, what they're going to get. And for our course they're going to get everything basically. The minute they land in Guatemala, transportation, hotel, food, accommodation, university – their tuition of the university, their temporary license. Everything is basically covered from the time that they are landing there. The only thing that we do not provide is for them to be able to go ahead and get themselves there and the ticket is not part of this program. So once you have your ticket and you sign up for our course everything else is – we take care of.
And we are going to teach you how to place – and this is an investment. I mean just like anything else education is an investment. I agree with Cory. You have to fund $50,000 debt. This might be a little bit hefty for you but certainly I can't imagine that there is any other course, as far as the price is concerned, to be anything close to what we have. I think the other competitors of ours are good 4,000 to 5,000 higher than what we charge but it's just like everything else education is an investment. And this is a discipline that we're going to teach them that they normally would not be able to make money with it.
Howard: And by the way I just re tweeted you. You're @drtermechi, Termechi, and I just retweeted you to my 23,000 followers. Thank you so much for following me @howardfarran.
So let's go to some of the basics that's in our mind, what do you say are the most controversies in implant dentistry and how you address that. That concerns a lot. They want to know. The biggest concern these associates are telling me is that they went into an older guy and he did this. He learned how to place implants. And now five years later 20% of them have peri-implantitis. You teach Implants and Perio, do you agree with that number that in 60 months 20% of implants have peri-implantitis and what does that – how do you wrap your amazing mind around that, Omid?
Omid: So I don't know where you get your stats from. I mean I don't know where that's really coming from. I don't know if we had that much peri-implantitis coming through. It would be a very, very terrible discipline this implant dentistry. We certainly do have a big share of peri-implantitis as the implants are being placed more and more each year in the United States and we see all the old ones coming through. I actually posted the case on Dentaltown this morning or actually maybe possibly last night I posted out. My first case that I actually posted on Dentaltown, it was last night and that was the topic. The topic was to try to avoid and most people don't recognize to try to avoid as much as possible peri-implantitis in the long run. Peri-implantitis sets in, in the long run. It's not a quick problem. It's a long process that's going to come about in the future.
Now one of the things that I do is one of the things that I mean Cory teaches as well is we got to make sure that we have a good sound amount of bone around our implants. A lot of times when it when people who kind of just want to place an implant and don't have any other education beyond that, they place the implant in a very thin buccal area. And as the tooth goes into function of many years of being in function and that bone with all the pressure that's exerted on it, it starts going away. Then bacteria sets in and it seeps right through on the buccal. And that most the time we see it on the Buccal area we don't see it on the lingual. Why? Because you just have more cortical bone on the lingual side and must stick a bone on the lingual sides and therefore you don't see it on the lingual, you see it on the buccal. So one of the things that we want to teach our participants is the fact that recognize these patients are possibly maybe not for you to tackle at the very beginning but try to go ahead and get a little bit more comfortable.
And then there is a bone graft course that you can go ahead and take and more education to be able to go and do it. So most of the time even if my implants are exposed as far as the threat is concerned, if I see there is a thin amount of bone that's covering my buccal side of my implant, I opt for a bone graft and I suggest that everybody does only because in the future you would have a problem with that.
Howard: Well, you asked where I get my data from and I've podcasted a thousand people like you and I so I just went to perio.org, that's the American Academy of Perio Studies and they said at nine years 36.6% of implants have peri-implantitis at nine years. And I've seen several studies that at five years it's 20%. So it is it is significant. It's also the people that get implants, they're usually not your vegan, yoga instructor. You know what I mean and they also seem to have a lot of habits. I mean how did you end up losing all your teeth? A lot of smoking, drinking, eating crap dinner, forgot to join the gym. You know what I mean? So a lot of times I see that with (Inaudible 00:38:27) where they were disaster mouths and then they go get all that done then they come to your office and they've got half a loaf of bread underneath their fix so patients are patient selection.
So you guys cement or screw? A lot of people think the cement has something to do with peri-implantitis. You guys cementers or screwers?
Cory: You go ahead.
Omid: Why do you want to ask that where I get (Inaudible 00:38:49)...
Cory: Yeah. So I am actually one of the few that's on the cement bandwagon. But with that said I want it on a custom abutment and I want that abutment to be a half millimeter subgingival on the facial and everywhere else like in a proximal (Inaudible 00:39:06) or equigingival. And on the lingual I want it supragingival because cement, when you put that on and just as long as you're not putting a massive amount filling the crown up, it's going to flow out of the path of least resistance which in the case of how I design them is going to be on the lingual where it's supragingival. And to me those are just ten times easier to deliver. I'm not worried about two paths of draw. With the screw type you've got the path of draw with the screw and the implant plus the path of draw with restoration with the contacts. And I just think they're harder to deliver. So I am preferring cement retained but are custom abutments. I don't know. What you think, Omid?
Omid: So this is – I remember I was in my implant residency back at the beginning of 2000. Everything is being screw retained back in the 90s. And then it comes to 2000s, beginning of 2000s, everybody says it's more aesthetically pleasing to go ahead and cementable. Why? Because I don't see the (Inaudible 00:40:12) running right. in the middle of the implant. Sometimes you really can't do it because the position of the implants, the way it's positioned.
And now today again we're going back to that whole process of selling the idea of screw retained. Certainly both of them have their advantages and disadvantages. I mean I had my share of (Inaudible 00:40:31) where patient functions on the (Inaudible 00:35). So that's your screw retained issue and maybe you can get it out, maybe you can out. And then obviously peri-implantitis and cement that we are – you were just discussing that even though we have a lot of that problem. So personally in my own practice I pick and choose based on a particular case whether I think it's a cementable or a screw retained. And it really becomes a clinician judgment call to figure out if I do it this way or the other direction, which will add issues to the patient. If they both equal out then I can consider aesthetic of it and see whether I want to go ahead and put the screw in the middle or not. So to answer your question, I'm 50-50.
I believe that the cementable definitely still has a place in the implant dentistry. A lot of my colleagues don't even go close to it any more. That's it for everything that they do. Some also – to go ahead and try to get the screw retained on their implants. I don't necessarily do that. I still use cementable and occasionally I posted my second case or a third case on Dentaltown today and it's (Inaudible 00:41:48) aesthetic zone. And that one is a screw retained. I'd like to actually – that when it comes to aesthetic zone, I like to go ahead and go more on the screw retained. I have more ability to manage the soft tissue and the zenith of the of the maxilla.
Howard: But I want to tell you kids one thing. You stay out of that aesthetic zone for the first hundred. Don't even get near there. Your starter cases are something I mean I guess it seems so easy because it's right there, it's in front, you can see it. Oh my God. For one of the first implants I did was number 8 on a gorgeous girl and think I had a prosthodontist and implantologist that I could that I had to go give several thousand dollars to redo the whole thing. So start in the back.
I want to ask you another question. 30 years ago when I got out of school implant success is how long you could get in there. I mean oral surgeons were doing mandibular nerve, move a mandible or nerve to get them extra long, long, long.
It seemed like the trend is that implants are actually getting shorter and fatter. Where are you at in implant success being long. Who's the guy on Dentaltown from London that always places these short fat – Bill...
Cory: Bill Schafer (00:43:06).
Howard: I mean that guy, I mean. And a guy like me wants to always promote short and fat. I mean if there's anything I hate, it's tall dark and handsome and skinny.
So where are you at on the evolutionary scale between a tall dark and handsome implant versus the short fat one so you don't have to worry so much about the (Inaudible 00:43:24) or even sinuses?
Omid: So I don't – there was a literature that came out in, I believe it's the Perio, that if you have to sacrifice one of the other, which one would it be? Thickness versus length. What would you sacrifice if you could go and sacrifice one? And everybody agrees that you sacrifice length for width. So width of the implant definitely is a major aspect of the implant that gives you a great success in the long run. The only problem again is it comes about is whether you have bone or not. I don't believe that you need to go anything beyond 10 millimeter in order for you to go ahead and accomplish it. I know I myself, I place a 13, an 11 and 1/2 when I can and I see the bone there. But here is the problem, Howard. I think one of the big, big issues is what we just mentioned before is peri-implantitis today.
Can you imagine having an implant that's 13 or 16 millimeter long? And now that implant is suffering with peri-implantitis and that implant is number seven area between your lateral incisor and a canine. And now you as a surgeon want to go ahead and remedy that problem. That becomes a huge, huge problem for any surgeon to try to tackle.
If the implant had peri-implantitis, that does not necessarily mean that the implant is loose and is ready to come out. Unless you really need to go after it and get it out and then try to recoup the area with the bone or whatnot and just either repeat the processes or go conventional dentistry. So I don't believe going longer is necessarily better. I think as long as you have a minimum of 10 millimeter on your implants you're in good shape. Okay. Four by ten is a standard all around. You could put it in the posterior maxillary or put it in the anterior mandible. It all works and it's good size implant for you to be able to place.
In the past we used to go ahead and consider putting bigger implant in an aesthetic zone and in immediate cases where you took out a central incisor and now you're putting a five or six millimeter implant in the central incisor area. Today we say no you don't need to go that big. You can go put a regular four and try to preserve more bone in the buccal area. So you have a thicker bone with a narrower implant is a better process rather than a thicker implant with a thinner bone in the buccal area.
Howard: I want I want to ask you this question. If you had – you're in a New York City area. You're on Long Island. What if Lady Gaga came in your office and she was missing number eight? I mean there's a lot of people, myself included, I think that if the aesthetics is your top priority, a three in a bridge it’s probably more aesthetic than a single implant crown on the four maxillary incisors on a beautiful woman with a high lip line. Do you agree with that or disagree with that? What would you do on Lady Gaga? She's missing number eight. Three in a bridge single implant.
Omid: So that's a very broad question. A very, very broad question only because you have to also consider the situation or the circumstances that that patient presents itself. And if I go ahead and I take a look at Lady Gaga and I look at the literature and I see that she fits under the diagnosis of the literature. That I can go ahead and if you have the experience of it and you keep this process over and over again. And you know that you could go ahead and do it. And then if I can try to get the aesthetic result that I get normally with an implant, I will certainly go ahead
And again, I posted this case where a 46 year old male came into the office with an accident and tooth number eight popped out and soft tissue is missing, the bone is missing. And if you take a look at the very end, the last slide where it shows that the tooth is in his mouth, you can certainly see that the aesthetic is well-preserved. Now I do agree with you that a lot of time you got to just say an implant is not the answer here and you got to just go back to the conventional dentistry with the crown and bridge and you probably get a better result. I do agree with you. There are cases that it's probably best for the patient to go with the three on a bridge or six unit bridge, whatever the case may be, I suppose to go ahead and try to accomplish that two implants.
Howard: Yeah. Same question to you Cory but since you're in Winchester Tennessee, instead of Lady Gaga that had to be Dolly Parton. If only Dolly Parton came in your office from Opryland USA, what would you do? If that was number eight, would you implant single crown or three in a bridge?
Cory: I would say sorry, I've retired from clinical dentistry. So, I mean, okay, let's assume there's plenty of bone there. With plenty of bone. I would do the implant. If the patient is going to have to have soft tissue grafting and add bone volume and multiple procedures. And let's say that both adjacent teeth have MIFL composites on them that come under this bridge at that point. So again it is pace dependent and it all goes back to the bone and circle back to what I was saying earlier.
This stumped me for the first six years of my career that I would place this implant and I would get this great primary stability and I would come back. I would bury it completely come back. There's no exposure of the cover screw and I'd take an X-ray. And where it had been a millimeter under the bone, now there's bone loss down to the first thread. And it's not even been exposed to the mouth anymore.
And what I finally realized and a lot of this came from a lecture that Dr. Lerner gave in his Sinus Series was you're placing it into the short ridge, you've got a tapered implant. The highest pressure is up here at the crest where the bone is the skinniest. And so you're putting in greenstick fractures. You're right against these cortical plates there's very little residual bone around this. And I don't care if you do bury it. That bone is going to melt away. And so I would, in that case, go with a skinnier implant to try and preserve some actual native bone around that implant.
For most dentists I would say the safe bet is going to be, in Dolly's case, to do the three in a bridge because you're talking about some serious skills if you got to be able to regenerate hard and soft tissue. If it's plenty of bone, plenty of tissue and you had enough experience in implants I would go for the implant.
Omid: I want to just jump in for one second here. DISS is definitely for beginners. Our goal is really to go ahead and get their hands wet and let them place 15 implants or so in our program and learn the implant industry, understand bone, feel the bone. Our participants who have already signed up they are averaging somewhere between none to 30 implants in their career so far. So one of my participants said to me, he says, I have placed him and say my practice. My son and my son-in-law are dentists and they place implants. But every time I get a implant case that's coming in I start sweating from the day before. So that's – our goal really is to make them comfortable. We want them to be comfortable and recognize – but no aesthetic involvement of any sort. Later on in the future once they get more comfortable and they educate themselves then they can try to tackle that. But I would definitely not suggest that for them at the beginning.
Cory: And also, let me just tell you one other thing, Howard. One of the things that we're doing that – I don't know if anyone else is doing this but I think it's going to be a big benefit to the attendees, is with all the 3D printers and everything that I've got and the fact that we're doing it guided means that we have a cone beam on these patients ahead of time. So one of the unique things that we're doing is we're actually going to 3D print that actual patient's jawbone out and they're going to get to do a mock run at the surgery. So let's say your first case in the morning that you get your first ever implant, the day before or that morning you're actually going to have that patient's jaw and you're going to do the mock surgery on their jaw and be able to anticipate potential complications. And just you get a dry run out of it. It's really beneficial rather than just some stock practice model. And so that's one of the things we'll be doing for all of these patients.
Howard: Okay. Another big question I have is one stage – I mean one stage or two stage surgeries, there's a lot a lot of patients the tail is wagging the dog. They want the immediate loaded. They want to walk in, get the implant, walk out with the tooth. What do you think about one stage versus two stage and immediate loading and does your course go into that?
Omid: So we're definitely going to discuss doing the one stage versus two stage as far as the implant is concerned. Certainly the days of (Inaudible 00:53:06) where he came in a place of making type implants and it was a two stage type of implant and put on the soft tissue for six months then come back and recover and then start the restoration. Those days are kind of over and that's partially – thanks to the surface area, surfaces of the implants today that we are just more technologically advanced as far as the implant surface is concerned. So we have great surfaces that all implant companies have good service. And that's definitely great benefits and the integration is much, much faster. So we definitely are going to touch upon where to go ahead if you have one stage versus two stage. As far as the immediate load is concerned our program is not going to touch upon that because that's a little more advanced. We are – whether it's aesthetic area or whether it's a full mouth kind of a construction that's kind of falls into the more advanced cases. But to answer your question, it's a very mixed attitude in the world of dental implant attitude today.
If you had a patient that comes to your practice and aesthetic (Inaudible 00:54:18) is an issue and the patient, let's say, you see a patient (Inaudible 00:54:23), a lawyer that goes in front of the judge and it's – or a businessman or whatnot. These people don't want to walk around with teeth that pops in and out. So maybe five to six years ago we were doing all these immediate cases one after another.
Although the literature does show that immediate cases are almost as successful as a regular implant, conventional implant placements. And I say this because the clinician is very selective of who they pick. It's not because immediate. It's an easier procedure or immediate –we're not putting implant more in jeopardy by doing it. But we are very selective of who we pick. A lot of times whether the implant is in there and it's well-fixed into the bone, whether you get a good amount of torque on the implant, whether the patient is not a smoker and they're healthy patients.
So we pick and choose when it comes down to immediate cases. But when we come down to regular implant everybody falls into the category of, okay, we're going to place an implant and we deal with it whatever happens. So immediate cases are very successful but I definitely do not recommend it for beginners. Go ahead and do that especially in the aesthetic zone because that's just generally very tricky. You just got to know a lot of different – the placement is soft tissue and whatnot and then it just takes a few more years.
Howard: Yeah. And, yeah. No doubt. I know the family trees are a great place. the first The first dozen implants I placed was on – I needed some free volunteer research monkeys. So I just started going all my family and that was great.
And another thing that's always on their mind, a lot of thing they're asking is platelet-rich fibrin a PRF? Is that something you need in your armamentarium for your average bread and butter implant or the use of sticky bone. Is that a – do you think that's overkill or is that necessary armamentarium for your average implant, general dentist place? And by the way you have to place 50 a year. I can tell you I'm a dentist and an MBA and I love dentistry and I love the business of dentistry. And I have never seen anybody in the profit zone doing any procedure less than one time a week. When you're doing an implant once a month, a denture once a month, a root canal once a month you're so damn slow. You're sort of slow, you're not in the profit zone.
So if you're going to set out on Implantology or Invisalign or sleep apnea or anything – I mean look at sleep apnea. You could drop 30 grand just trying to learn sleep apnea. And then what, you go back and do one case every quarter? would you want to go to a doctor and be treated for sleep apnea who did four cases a year? So the critical zone is once a week. So back to that dentist who's going to set out on implant journey. And they got to get to critical mass, the tipping point, profitability, the profit zone, one implant a week. Is the use of platelet – PRF, drawing blood, spinning blood making sticky bone, is that part of the protocol?
Omid: So it's certainly not part of our protocol only because I do agree with you. When you are at the beginning of your implant journey I don't think that that's something you need in your practice right now. When you start getting more active and you're placing more implants then it becomes a little bit more. And that's really – it comes into – we're going to teach, Cory and I, we're going to teach a bread and butter type of implant dentistry where not too much bone needs to go ahead and get enhanced and not too much of soft tissue involvement or whatnot. We really want to focus on a basic of implant dentistry. But to answer your question I would just throw this at you right now. To answer you I'm going to give you a statement. Your listeners can decide whether they would fall into this category or not. In order for you to justify PRF you have to do much bigger surgeries where PRF comes handy as far as your bone enhancement and soft tissue healing. So if you are placing two or three implants where you do not have to enhance any bone and you're not making tremendous amount of selection of the soft tissue therefore that PRF is not going to be too handy to you. And there's no use really for it because PRF when I use it is when I want to add a little bit more kick to my bone graft and I wanted to go ahead and create a membrane that I need to separate the soft tissue plus bruising, swelling and whatnot. And those go on to the category of a much larger surgery like a sinus graft.
But if you're doing bread and butter, two, three implants, (Inaudible 00:59:29) implants, things like that where simple – and again with a computer guided surgery we are trying to teach them to be less invasive rather than more invasive. And if you are going to stay like that and you really don't, at this point, need a PRF system in your practice and you don't need to invest on that just yet.
Howard: My god, I can't believe we already won. It's seven minutes past the hour. Holy moly, where the hour? Seven – they're sitting in the parking lot saying I'm at work. Would you guys shut up so I can go inside and see my patients. We do the show an hour because that is what their average commute is. And I want to thank you guys so much. Coming on a Sunday afternoon in the middle of the Tennessee Titans and the Arizona Cardinals. That's how much we love dentistry. We just sacrifice the NFL for dentistry. But I just want one final question.
Do you really think they need to learn how to place implants when it's right here on the news that Chinese robot dentist is first place implant in patient's mouth. They literally placed that implant with a robot in China. So why should the dentist learn how to place an implant when they can buy a damn robot from China to place that implant. Did you guys see that?
Omid: So I want to tell you, by the way, I did not see this but a friend of mine went to (Inaudible 01:00:49) New York dental meeting. He said that there is a robot now that basically what it does is, and Cory may find this very interesting, that you basically after you take the scan you plan the case. And then you hold the handle and you bring it to the patient's mouth. And you're doing the movement of the robot. But if you are diverting from your plan on the CT scan it will put some resistance and it will hold you back. So therefore, that, you could go ahead and go somewhere else. But the robot will kind of give you a little resistance and you will kind of have to stop. So but you're right, Howard. Who knows? Maybe the robots who will be placing implants soon and we may not have to go ahead and do this.
Howard: Yeah, that's why I'm not going to get married again until it is a robot. So I'm waiting for the robot that places implants and can be my next wife. And I probably – I just emailed you that article. I had Cory's and I didn't have yours Omid so I just emailed Cory. Cory, can you forward that to Omid so we can see that Chinese robot? Yeah, I'm going to go to China to see if I can get an implantologist robot wife. How's that sound, right? Hey thank you so much for spending an hour on a Sunday with me. Love your passion. Love what you guys do for dentistry. Thank you so much for coming on the show today.
Cory: Appreciate you man.
Omid: My pleasure.