Dentistry Uncensored with Howard Farran
Dentistry Uncensored with Howard Farran
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1070 Orthodontics & Implant Dentistry with Paul L. Ouellette, DDS, MS, AFAAID : Dentistry Uncensored with Howard Farran

1070 Orthodontics & Implant Dentistry with Paul L. Ouellette, DDS, MS, AFAAID : Dentistry Uncensored with Howard Farran

6/24/2018 4:57:55 PM   |   Comments: 0   |   Views: 666

1070 Orthodontics & Implant Dentistry with Paul L. Ouellette, DDS, MS, AFAAID : Dentistry Uncensored with Howard Farran

Certified Orthodontist, Paul Ouellette, DDS, MS, AFAAID has dedicated his life to his profession as an educator, inventor, humanitarian, philanthropist, author, entrepreneur and leading proponent of the implementation of cutting edge technology applications in dentistry.

Link to Dr. Ouellette’s “Shake the bone! Tap Tap for Rap!” video:

VIDEO - DUwHF #1070 - Paul Ouellette

AUDIO - DUwHF #1070 - Paul Ouellette

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1070 Orthodontics & Implant Dentistry with Paul L. Ouellette, DDS, MS, AFAAID : Dentistry Uncensored with Howard Farran

Howard: It is just a huge honor for me to be podcast interviewing a legend, Dr. Paul Ouellette. Thank you so much for coming by. Dr. Paul Ouellette has dedicated his life to his profession as an educator, online entrepreneur, inventor, and leading proponent of the implementation of cutting edge technology applications in dentistry. He currently serves on the faculty of a major orthodontic department teaching his residents interdisciplinary orthodontics, implant dentistry, and multispecialty practice management. Dr. Ouellette presents high energy, entertaining podium presentations in one day or more workshop programs on current 3D dentistry topics such as 3D, CVC, dentistry today and tomorrow, placeholder of TAD implants used to preserve crestal bone levels, adjunctive orthodontic techniques for preparing implant receptor sites, easy flapless guided implant surgery protocols, accelerated orthodontics and surgical facilitated orthodontics, practice management of the group specialty practice. Oh my God, how many dental offices have you started in your lifetime?

Paul: Thirty-

Howard: Orthodontic offices?

Paul: Well, no, I had multi-specialty centers mainly. And so thirty-three offices is what I have.

Howard: He had thirty-three offices!

Paul: Not at one time. Not all at one time.

Howard: And then you were friends with Gasper Lazzara who started Orthodontic Centers of America.

Paul: We go back over forty years and then Dr. Robert Pickron, Pete Pickron, the three of us were kind of the pioneers of marketing and advertising in orthodontics, giving away bicycles and things like that to get patients in. This is pre-Internet; Internet makes it a lot easier now. And I'm not saying that I was the brains behind it because Gasper and Pete were the ones that really took it to the next level. Dr. Pickron just sold twenty-three of his offices about six years ago in-

Howard: In Atlanta? In Atlanta, Georgia?

Paul: And he's retired teaching, his son's now an orthodontic resident at the Georgia School of Orthodontics. I was teaching in Jacksonville for a couple of years where my son became an orthodontist from J.U., Jacksonville, Jason Ouellette. And then my other son is a dentist, an implant dentist and sedation dentist trained with Dr. McCracken in Alabama, and he went to school offshore-

Howard: Ryan, can you find those? And you graduated from Loyola School of Dentistry in Chicago, 1970 with your DDS and then in '72 graduated Loyola School of Dentistry and Orthodontic Specialty and Masters of Science in Oral Biology. So you were an orthodontist in 1972. And how would you say- And by the way, that original trio I was just talking about, which was with Pete Pickron in Atlanta and Gasper Lazzara. Gasper lives in

Paul: Ponte Vedra.

Howard: Ponte Vedra, Florida, but wasn't he originally from New Orleans?

Paul: He was from New Orleans.

Howard: And those guys started Orthodontics Centers of America, which was the only one to date that made it on the New York Stock Exchange, the only one and it made it to a one billion dollar market cap. And today there's so many DSO's, and none of them could get publicly traded.

Paul: Gasper is a genius and it started out, I got contacted in Atlanta. I had Atlanta Orthodontic Care Centers, so I’m A in the phone book. So Gillette Corporation calls up, says, "Hey, we're kind of interested in getting into your field. Would you be interested in talking with us?" So they flew somebody down from Boston and I started talking with him. So I wrote up a business plan and I brought in Dr. Lazzara and I brought in Dr. Pickron and we spent a year with the MBA's putting together a plan for multi-centers. And then, there was some sort of a hostile takeover that was happening to them. So they divested of their medical businesses and so Lazzara then picked the ball up and did it. So he was the first DMO or corporate entity, and he's the billion-dollar guy. And then Dr. Pickron started OrthAlliance, which I was a member of that as well.

Howard: OrthAlliance?

Paul: OrthAlliance. And that was-

Howard: Can you find OrthAlliance, Ryan?

Paul: Now, most of those are gone now.

Howard: Is OrthAlliance gone?

Paul: It's gone. But Orthodontic Centers of America actually acquired it.

Howard: Orthodontic Centers of America?

Paul: Right. And then there was one called Apple Orthodontics as well. So there was three in the orthodontic area, and I was a member of all three of those. I participated in all three.

Howard: Okay, now this is Dentistry Uncensored. I don't mean in insults or in any way, but they all are out of business now.

Paul: Most of them.

Howard: And now the history, the pendulum just swings back and forth. So now you have a bunch of DSO's again, but Wall Street won't take any (unclear 00:05:12). There's none of them trading on Nasdaq. And by the way, someone sent me a deal today, "Howard, you're wrong. There is Berner management," but now that's a low volume. I mean there's that. Technically you're right and I'm wrong, but they're all gone and let you take the biggest one, like Heartland Dental, like, what is that investment group, KK who just bought Heartland? Was it KKR? Yeah. And can you find me everything KKR owns in dentistry, because they bought what else did they buy, Demand Force? But anyway, so private equity, KKR just bought heartland dental. But in your guys' day, they went publicly traded and then they failed. And, today, they're all owned by private equity. So let's talk about first, why do you think they failed? What business lessons could you share with the next generation? What went wrong?

Paul: Well, when the market took a big dump I think in around 2000, or a little before 2000.

Howard: March of 2000.

Paul: And I think that was a part of it, and then also the doctors' stock, they depended on their stock price going up for giving up a percentage of their gross to the management company, and the stock didn't really take off as fast as the doctors would like. So a lot of the doctors sued and got out of their arrangements. So that's kind of what happened. And I'm now with a VC, a D for C; Dentistry for Children, and also a dental brand. What is it? Family Orthodontics, and they have 60 offices. I cover about three of the offices right now.

Howard: What's it called?

Paul: I love it. I don't have to run it.

Howard: It's called, what?

Paul: D for C; Dental Dentistry for Children and then Family Orthodontics and it's Dr. Pickron's old practices, the 23 I told you about. And then, Ronnie Ikyl [ph.], who's a genius as well. He's a pediatric dentist. He sold his Pido centers and so they put Ortho and Pido together, and it is awesome. I have 12 new patients every single day just like clockwork. I don't have to pay the bills, I don't have to worry about staff. They take care of everything. And so for my next forty-seven years of practice, I'm going to be with them. So, have you been doing it forty-seven years?

Paul: I'm in year forty-seven now.

Howard: Nice. That is awesome. So, you know, podcast people are younger-by the way, please send me an email, Tell me how old you are, where you live, what country you're from. And also remember to watch this and subscribe to our YouTube Channel But, but people our age, I mean, you know when you get on an airplane, the guy next to you is reading a book, you don't have to ask if he has grandchildren; you know that. But it's the millennials, they're all doing the podcast, YouTube thing. How was orthodontics different today than in 1972?

Paul: Well, in 1972, I guess it was kind of the golden age of orthodontics. We did not realize it, because it was a referral type of relationship with your family dentist and your other specialists, and you'd go to Dental Society meetings, you would lunch the doctors, lots of PR being done. There was no emails back then, so we would do letters. And of course when we got, when we got laser printers and our letters started looking like printed pages. That was huge, because orthodontists could afford to buy the laser printer. My first laser printer was an Apple, and it cost me five thousand dollars just for the printer. And so, I always myself, would try to embrace new technology. When the Internet happened I was able to get a couple of URLs which had been huge for us, and And so, when I sold my last six practices, I held those out for my boys. So Jonathan got dental specialists, and Jason got affordable braces, and so they use that and of course now Google is the eight hundred pound gorilla that you have to market with that now. I don't have to worry about that anymore. We have a whole marketing department that does the PR, so I have somebody that comes by maybe once a month and we go and see three doctors. We take them to lunch, they do the doughnut runs and everything and we try to meet as many of the doctors as we can. So we're still trying to do the personal relationships. But most of the dentists now are doing Invisalign. So our referrers are actually our competitors now. But that's okay. We can still do difficult surgical cases. Maybe we won't make as much profit, but it's sure a lot of fun doing the more difficult cases.

Howard: Well let's talk about that, because when orthodontists talk about they're losing a lot of cases. Did Invisalign, if you look at the Invisalign stock, I mean that's a billion dollar market cap. And when I look- and let's go back to 1972. You graduated in '72 as an Orthodontist. I was born a decade before that. And back in those days, big old families, you know, like my family; five sisters and a brother, seven kids, only the most gnarly looking child would the family pay for ortho because you didn't have enough money. But now it's like the family sizes are two kids. Everybody gets Ortho. Every woman that gets divorced wants to come in and get bleaching and Invisalign. So, I looked at the Invisalign data. I listened to Joe, is it Joe Hogan, Ryan? The CEO of Invisalign; Joe Hogan? Joe Hogan. So Joe Rogan is the MMA fighter announcer and Joe Hogan- and I mean, Ryan and I have been shocked, I mean, we'll be in luxury in Cambodia, Malaysia, Indonesia, and the, and the twenty-two year old waitress in this poor country and she's wearing Invisalign. So, it looks like the market is growing so fast. Is there enough for orthodontists and general dentists, or do you really see the general dentists really taking a bite out of the orthodontists' gross?

Paul: But, I also see Invisalign taking a bite out of the market as well through the Smile Direct Club.

Howard: And they bought 17% of that?

Paul: 17 to 19% of it, and they are doing the exactly the same plan they did when they launched Invisalign. They spent like forty million dollars a year. I might not have the right numbers, but it was a huge amount of money on advertising and they drove patients to the dentist chair, or to the orthodontist chair. And then there was the lawsuit that the dentists said, "Hey, it's not fair that you know, you're only doing Invisalign for specialists." And then, Align Tech decided that, they would settle the suit and now they're doing it for the generalists, still doing it for the specialists and now they're doing it directly to the public. And so they're our competitors now as well. So the market is really getting complicated, but that's why multi-centers and implant dentistry is the future in my opinion. And that's kind of where we're focusing on implant dentistry.

Howard: What is the future of dentistry?

Paul: Implant dentistry is like one of the, I don't know what the percentages are, but there's very little uptake because it's so expensive, and that's one of the things I'm trying to do is bring the cost down of implant dentistry so that a patient can afford to get an implant and a crown and the system that I developed-

Howard: This is the one you developed?

Paul: Yes.

Howard: Go through what you developed.

Paul: Okay. Well first of all, I'll show you the cover of this, but anyways this basically shows how an implant can be put in by somebody, an orthodontist does not do shots. They don't do splats, they don't do sutures. All we do is point our fingers and tell our very talented technicians to do what we want them to do because we use our brain. So, I try to develop a technique of putting implants in that me, an idiot, as far as a dentist goes, I haven't done the shots and all that. My son Jonathan loves to, you know, lance an abscess, and he describes it to me and I get sick. But anyways, so everything can be done with hand tools. You don't have to have a four thousand dollar motor. So, I have everything designed to where this'll fit into a four-thousand dollar motor if you want to buy an implant motor, so it has a latch on it and that that's an osteotome. And then it also fits into a handle. So here, I do missions, so if you can go out into the field and do dentistry and put implants in without having, you know, all this stuff that you need. So, I developed a surgical guide, a technique to where all my instruments are designed from the tissue punch to go through the guide. And, and so an orthodontist can work with a company like Anatomized, and they will go ahead and set up the guidance for you if you want to put an implant in.

Howard: Is it Anatomized you recommend?

Paul: Well, this is who I started with when I was doing this.

Howard: Out of San Fran?

Paul: San Fran, yeah. I went out there right when he, when Jack First started his company, I was out there, and also, Bob Boyd had a lot to do with Jack being where he is today too.

Howard: Jack is the CEO?

Paul: Choy, Jack Choy.

Howard: You think you can get them to come on the show?

Paul: Well, I haven't talked to Jack in a long time. So, I will touch base.

Howard: We've got so much exciting new stuff.

Paul: Oh, that's a really good company, because they're into the medical anatomy tables and everything. And their software is awesome. They have, they're the ones that came out with 3D cephalometrics, and I did an early study with 3D cephalometrics to show that everybody has anatomical variation. So we're not going to get perfection in our Ortho cases, because you can superimpose the right half on the left half and there's so much variation that teeth are different sizes, the bones are different sizes. So we're lucky we get the results we do.

Howard: I hear it's worse in countries like America and London and Canada and Australia where everybody's a mixed mutt.

Paul: Yeah. We're pretty mixed in the US too.

Howard: But yeah, that's what I'm talking about, versus come countries, like you can go to Vietnam, they're 95% Vietnamese. You come to America, Canada, London, Australia, they're 100% mutts.

Paul: Heinz 57, Fifty-seven varieties. So anyways, to get to this, I designed the implant, it's called a TAD plant, TAD means Temporary Anchor Device and Plant from implants. So it's basically a TAD, and I didn't design it so it would super integrate. It goes in like a Post-it note, you know, like you stick a post-it note on the wall, it's not going to take the plaster off. It's not going to harm the implant site. So, you can put these in, it has a prosthetic platform. It also has a scan body so you can scan it with the three shape software or, or some of the software, lamp softwares and have a crown made for it. But everything's provisional. Everything's temporary. Usually PMMA is what I use. But you could put a permanent crown on it.

Howard: PMMA?

Paul: Polymethyl methacrylate; which is plastic and acrylic. And so, the implant goes in, this can go in and this could be a pediatric implant. They say you can't put implants in in young children because you might stunt their growth or, or harm the implant site. Well, there's ectodermal dysplasia patients where they're missing multiple teeth and what do you do for these kids? So they, they actually are putting full size implants in those patients, there are several articles that show that. So I went ahead and made a very, very small implant. This is how small it is. And I had all these developed in Korea with a company that's been doing this for 30 years, and they do wonderful manufacturing. And the company that I'm dealing with was FDA approved for their line of Big Boy implants. These are either pediatric or temporary implants that will hold the bone. It'll hold a crown and you can back it out easy. My son is taking one of my clinical trial cases, she's had it in for four years and it's coming out. It either came out this week or is coming out next week and then he's going to put the more permanent ones in there because she's in her twenties now. And, but the reason that an orthodontist should be looking and helping out in implant dentistry is because we studied growth and development. We know how the Maxilla is a moving target. It is remodeling into the thirties and forties and so a lot of doctors are putting in a permanent implant that's so integrated, they have to use a trip line to cut it out like a hole saw and cut it out. They have to graft it. And I had one case that I was working with a periodontist that I use from one of my lectures. He gave me all the slides and everything. The patient spent about eight thousand dollars having a lateral taken out and having all the surgeries he had to do. So, this poster was presented to the ICOI; International College of Oral Implantologists in 2015, it won first place. So then I got invited to do main podium at the Trump Darrelle in 2016.

Howard: Where was the Trump Darrelle?

Paul: That's down in Miami.

Howard: The Trump Resort?

Paul: Yes.

Howard: Is that where d goes Trump when he's gone to-

Paul: No. He goes to Mar a Lago, which is up near Palm Beach.

Howard: But it's another Tump Resort.

Paul: He's got resorts all over the place. Now he has one, what's the name of the avenue there? The White House. But anyways, Pennsylvania Avenue, this, this shows how the implant is put in with hand instruments or it can be put in with motors with a, with a surgical guide. Again, I see.

Howard: That would make sense and everything in the soft maxilla. But what about the mandible?

Paul: Oh, sure. You can put them in anywhere because now the hand instruments are designed like the osteotome; you just tap it once, you break the cortical plate and then these are self tapping, you just screw it in slowly, it expands the bone as it goes in and you can load it right away if you're going to like move a tooth with it.

Howard:  Now this is a question that comes on dentaltown; so you have an idea, let's use the implant companies, like what percent of implant companies would do an original and manufacturing of your idea because a lot of dentists out there and say, "Well, I'm afraid if I go to a big implant company tell them my idea that they're going to steal the idea."

Paul: Well, there's a thing called an NDA before you divulge anything and you also get a patent. I have two patents on it.

Howard: Did you get two patents and an NDA before you talked to a Korean implant manufacturer?

Paul: Well, no. I went offshore and had somebody in Korea that I met somehow through meetings and he helped me out. Patrick Kim is his American name, Patrick Kim. He's excellent. He and I have a handshake. He is not going to steal it. Like he doesn't want me to go to another company. I already have talked to another company this week, "Oh, well we'll do it for you." And I said, "Well you have to call Patrick Kim and talk to him?."

Howard: But before you talked to him, did you already have patents?

Paul: My last, I just in the last, it took me five years to get all the patents, and I still have one patent left.

Howard: But he was making it for you before had the patent?

Paul: Yes, because I was doing clinical trials at Jacksonville and Georgia School of orthodontics. We just opened so we, we don't have any research going yet, but we will. So one of my doctors I recruited that's teaching there, she is going to go ahead and do clinical trials.

Howard: Is this in Atlanta?

Paul: This is in Atlanta, with permission of the chair of that department and I don't want to say she's going to do it, but we're going to try to get permission. The only thing I have left to do is a 510K, FDA, and then I'm ready to go to market and the way I'm going to package it, it's not going to be an individual vials with a number on it. It's going to be like a bone screw, so it's going to be a bone screw kit so you'll have all the sizes that you need. You'll have the surgical instruments. There's only like three or four instruments you need to put them in and you don't have to have numbers on it. The page, the user sterilizes it, so that takes the sterilization out of it, so you can keep the packaging costs down because it's going to be in a bone screw kit. And so, a bone screw, like there's little plates that can be put in for fractures and so on. Well, as Orthodontists, we put plates in with a couple screws to do traction. And so my system, I'll be able to have a bone screw as part of it, and I can put the plates in and we're going to use it for sleep apnea patients as well, to advance their maxilla and, and so it's a temporary implant. You don't want to put a permanent implanted to treat sleep apnea patient, you're going to be able to get it out.

And the nice thing about the TAD plant, if the body's changing, and the maxilla is growing away from the implant and you're getting the exposure of the buccal surface there, you can back it out and put another one in, or you can put a permanent implant in if the patient's old enough and that should be a close to thirty and over. Then what happens after thirty and you get to be forty, here's the thing that I'm an expert in, and that's called aging; you get older. And, I read all this stuff that I could get my hands on about aging in the mandible and how the implants are getting exposed because the mandible is changing as we age as well. And so, I have a lot of references in my lectures that show that we have a moving target we're working on. So, why are the company's pushing super integrated implants in areas where they might have to be taken out? You know, you can really, you can spend eight thousand dollars when you take one out and you have to regraft it and reestablish the site. 

You can also use teeth to build implant sites. So that's adjunctive orthodontics that I like to do. So, I might take a cuspid and moving all the way up against the central and then move it all the way back and we develop an implant site. Dr. - I’m in Washington, one of our great contributors in Orthodontics, I can't think of his name, Vince Kokich, Kokich. He died, his son lectures now. He would be somebody good to get on your show as well.

Howard: Well, you introduce us.

Paul: I don't know him as well. He’s just of the, of the great minds in orthodontics. That is kind of their experts in dentistry.

Howard: Can you find him, Ryan?

Paul: And Vince was the, he was the editor of our journal orthodontist.

Howard: He was the dad?

Paul: He was the dad, he passed maybe two, three years ago. He was a great man.

Howard: What's his son's name?

Paul: I don't know his first name.

Howard: But, is he in Washington?

Paul: I think he’s out there in DC,We had them in Jacksonville. He came to Jacksonville and lecture to the dental society events. He could be Vincent Junior. Okay, so he takes his dad's name.

Howard: And by the way, the millennials. Do you realize that when we were your age, the best we could do is go to the biggest downtown library where they had all these phone books and if you are looking at... just just to have this conversation in the eighties, we’d have gone down there and pull up a bunch of these-

Paul: What was those little cards you used to get with you, you had to go through all the cards and go find the books?

Howard: Sometimes when you go to a dentist, I'd go down to the Phoenix Library and look at twenty different phone books. Because you knew he was from Virginia. Yeah. So you had to look at ten different Virginia phone books trying to find some dentists name and phone number. So this shows how, I have animations that showed the surgical guide being used manually and I'm with a motor, I have over thirty-some instruments and components for the system that have developed over the last five years. And then this is exciting; this patent is called Ortho veneers and so what it is, it's basically a, veneer, crown or a bridge that’s designed with a monolithic integrated orthodontic attachment on it. So you just design it on the software, I've been using three shapes, software and we have a library. We put a brace on it and then we 3D print it and either additive or subtractive printing. And the materials weren't there when we first started with this idea. The materials are here. So there are materials that are FDA approved that can be used in the mouth over twenty-four hours.

Howard: So Align Tech owns invisalign and I Taro?

Paul: Yes.

Howard: You seem to be mentioning three shape. It sounds like you liked the three shape oral scanner better than the-

Paul: No, not necessarily because both my sons, my one son, Jonathan is a Serac instructor, so he has Serona, Serac. He also has an Itero for is invisalign cases, and my son Jason just bought an Itero Element. That's the new one, and he practices with a super guy. I should get you and I will introduce you to him. Dr Joel David and associates, he's in Jacksonville. He's probably the largest user of Biohorizons implants. I believe he's one of the largest users.

Howard: Out of Alabama.

Paul: No, no, this is a north Florida.

Howard: No, Biohorizons company. 

Paul: And they also support the course where my son was taught with Dr Mccracken. So my son is via horizons all the way. That's all he uses. 

Howard: So, you think the oral scanners are pretty much, you identify Serona ITaro or Three Shape? 

Paul: And 3M, I've used 3M’s

Howard: 3M’s dental care.

Paul: I’ve used Carestream's. So I've had three scanners that I had a bio in my research because everything is scanned. And so, there are cases that, let's say a bombed out case comes in, and the patient has to have some of the teeth removed, they might need some dental implants, but you know, the teeth tip and so the orthodontist has to upright them. Well, the case needs to be cleaned up. And so the Ortho crown has done in temporary's, but you put the orthodontic appliance, you design it into the crown, you straighten the teeth and then you buff off the attachments and now you have a temporary veneer that we can bond a little clear wires. And then the patient as they can afford it, they can have this quadrant replace that quadrant replaced. So, that's the Ortho Veneer Ortho crown system. That patent is about ready to come out  hopefully this summer we had to do a couple of revisions. So here's some images of the Ortho Veneer Ortho crown and you don't have to have an orthodontic a bracket. I have some in the patent description where I have a stair step slots on their tooth. And so if you want to do guided bone regeneration and you want to extrude the tooth, you just put it up, it's like a ladder. You put the wire up into the first one, you bring it down a little bit, put the wire up into the second one, bring it down a little bit, of course you have to file it off, reduce it because it's going to be in super occlusion so you can use orthodontic veneers to straighten teeth, and then also create a temporary situation where patients can save their money and then have it replaced. Same thing with the implant. My goal is to have a twelve to fifteen hundred dollar implant and crown that the mass public can afford. And then if they want to go ahead and get the high cost implants, if they're old enough, they're not having those bony changes, then they go to a good company like Biohorizons or Biomed or Zimmer. I took implant training and I happened to practice with Dr. Ed Mills, he's another good one that you ought to have. He's awesome too. He's taught more doctors implant dentistry than anybody that I know. He's for 26 years, the ran the Maxi course in Atlanta and I practiced with him in his office, so that's where I got introduced to implant dentistry and about 2005. And so I ended up taking the Maxi course and then did my AAID. So I'm associate fellow of the implant dentistry, but I can't do the next levels because I got to do bone grafting. I've got to do extractions. I don't like needles, I don't like sutures and I'm not going to do that. So, I'm at the entry level and certification, but I use it for my lectures and education. So the Ortho veneers and the a TAD plant kind of goes together and I'll show you an example.

And this is the case that my son is replacing the implants with a permanent Biohorizons next week. These are the Ortho crowns and I designed it to put the TAD plant palatal. Now why would I want to put it palatal? Well, the crest is growing down and back. And also you want to preserve the buccal plate. I learned that from Dr Mills, you know, when I was studying in implant dentistry, so I put the implant back in the Palette and then I put a crown that I kind of hang off of it when I take this and show it to labs, “Oh no, you have to have an emergence profile. That's not right. Well, I don't want an emergence profile. This is a temporary.” You know, they put bone screws in a fixation in your back, you know to line your backup and so on how many years of those bones screws been in patients? Twenty, thirty, forty years. And then there are articles I read where they can get them out easy. So I said hello! I can do that with a regular implant. And so that's what I did.

And so if you can see in the illustration here how the crown’s designed a lot different. It's not put in ideally; it's put into the palate and then it does not harm the maxilla that is growing down about four to six millimeters and back about two. And that's from Barrance, he's the head of the HAO, Not HAO, the American Journal of Orthodontics, and also he's the chairman at St. Louis. He's a very famous guy, and his early research showed that there's changes that happened in the thirties and forties and fifties. He has a really good database and most dentists don't know about that because they're not orthodontists. Most orthodontists don't do implant dentistry because you know, they don't want needle, they don’t want sutures and so I was very lucky that I just happened to be exposed to these people. So I came up with this concept.

Howard: This is amazing. 

Paul: I don't know if it's amazing. I'm sure having a good time.

Howard: So what's your next step on your journey? So tell us where you're at in your journey? What website can they go to today to learn more about you and what you're doing?

Paul: Well, I'll send you to my son's two websites: and DDS, That’s my two boys.

Howard: Okay. So what's the first one? What's the first one you said?

Paul: Dream Dental Services, and then is my son Jason. Georgia School of Orthodontics, you can go to their website, Jacksonville's website. Jacksonville was the largest orthodontic program in the country, probably the world. They had fifteen residents every year and five fellows, and then Georgia School of Orthodontics opened up and we took twenty our first year and eighteen last year. So we are very large orthodontic programs, and so we have dentists that come in from all over, mainly kids that get out of school that want to be orthodontists and it's so great working with them because they're all videogame-raised and so the technology that we use, they can show us how to use it. And at Georgia School of Orthodontics, we take no impressions. Everything was digitally scanned. So we have like four to five 3Shape’s, we have some Carestream’s and I don't know if we have iTero’s yet, but I think we will be getting those. I'm no longer at the school because I was made an offer at D for C that I could not refuse. So I practice fifteen days a month with them.

Howard: So tell us more about D for C.

Paul: Okay. Dentistry for Children, they’re based in Atlanta. It's a venture capital firm that bought out the venture capital firm that bought Dr. Pickron’s practices when he retired and Dr. (unclear 00:33:44) practices, so they're the second VC that came in, and so supposedly this year we may grow to about three hundred sites.

Howard: Let’s talk about that because it seems like back in the day when you and Gasper Lazzara, you got a big line of credit, you start buying a bunch of orthodontic offices…

Paul: It wasn't me that did that, it was Dr. Lazzara that did it. I just happened to be at the place to learn.

Howard: But you are an orthodontist during this timeframe when you were sitting at the same table with him? 

Paul: Yes, proudly.

Howard: But the endgame, people say, “Well, what is your exit strategy? What is your endgame for your capital investment?” It was to go public. Now it seems like what happens is a private equity group that's in the five to ten million group will go start a deal, and then they'll flip it to a private equity in the fifty million.

Paul: And that's what's happening right now.

Howard: To a hundred million. Well, what is the endgame? Is there eventually just going to be one hundred-billion-dollar equity fund that everybody sells to? You don't want to get your money too far from cash. So how do they get their cash back? What's the end game?

Paul: Right now, my son Jonathan is getting ready to double his practice. He's only in his second year of his and he's going into his third. He’s had two years behind him. He went from one seventy five to a million dollars in his second year, and he's going to merge with a one point seven million dollar practice. So, I am here in Phoenix to go to the Dental Entrepreneurs' Summit, which is at the JW Marriott.

Howard: Now, whose summit is that?

Paul: That’s the Dental Entrepreneurs Organization, DEO.

Howard: Dental Entreprenuers Organization. And who’s the ringleader-

Paul: Dr. Mark Cooper I believe is his name.

Howard: Oh, Mark Cooper!

Paul: Yeah, he’s a periodontist.

Howard: Yeah, from Seattle, isn't it?

Paul: Yeah, I think he was from Seattle. So this is his organization. Now the reason I'm out here is we're going to have VC’s, lecturing, we're going to have one guy that got eight times his gross for his practice. Right now Jonathan's telling me the VC’s are paying like four times cash flow. So Jonathan says, “Okay, twelve million in three years if I do this merger, and I'm going to sell out and I'm going to perio school.” He's forty-one years old this summer and he wants to go back to perio school. And so I said, “Jonathan, do it, do it.” I mean, look at my age. I got to get back to the nursing home here in about a half hour.

Howard: Will you tell us your age?

Paul: Seventy-four.

Howard: And so you want to do this for how much longer?

Paul: What do I want to do when I grow up? I don't want to ever grow up. I figure that the minute I stop and go to try to have fun, I'll probably have a heart attack or something. My mother is ninety-five years old. I just saw her last week and her name is Lynette Chuck Ouellette, she loves chocolate. So we gave her the middle name of Chuck, so I took her some M and M's when I saw her and she just loves me because I brought her the M and M's. But she was very active into her eighties. She was like a rotarian, and she recruited more rotarians in anybody in Bravard county, like forty-five, I think she recruited. So you just stay active. So I just, we have good genes and I want my boys to work as long as they want to. They're not as crazy as me. They, they actually go on vacations. I go on learning vacations and let my wife shop while I'm listening to a lecture.


Howard: But, I want to go back to a Mark. Cooper, we've had him on the show twice, right on Ryan? So, you were, these kids, you know, they're still just in dental school, just starting. You were back around when the original ones started. Do you remember what year Orthodontic Centers of America did their IPO?

Paul: Well, I probably was in my, maybe my tenth year of practice. ‘72, ‘80, ‘82, somewhere in that.


Howard: So you've seen them go to the New York Stock Exchange. There was a dozen on Nasdaq.

Paul: A few times, I’ve been in three offerings.

Howard: So what is it like, you graduated in ‘72, now it's 2018. What does the DSL market look to you? What is your historical perspective, and then what is your predictive-ness of where it will be in ten, twenty, thirty? 

Paul: I think it's going to be a huge influence because the kids coming out of school, you know, owe a half a million dollars. I mean both my boys, three, three hundred and a half a million, I think the other one, because they were in school so long and then they had to borrow money and so this is a great opportunity for the kids. Plus they get their experience and sometimes you get into these organizations like me right now, I just love it. They take care of everything. We have such quality control. I mean we have a compliance officer that it's his full time job, to come out and make sure we're doing everything right by Osha, our sterilization techniques are good. They take care of the staffing, the marketing, everything, and you have to have all those hats when you're doing your private practice, when you get out of school and there's a big learning curve, you know, and then you have to go borrow at least two to three hundred thousand dollars to open a dental office. So do you want to do a three to five hundred thousand dollar school loan and then do another two or three hundred thousand to open an office and take that kind of risk? So I think these DMO’s are going to be a bigger part of dentistry and there's enough capital out there, I don't know where, I think it's a very good investment for these companies,otherwise they wouldn't be trying to acquire offices and paying so much.

Howard: So when your one son, two sons, announce to you, one's an orthodontist and one's in implants, would you recommend to the sons that they be a part of a DSO versus an independent, privately owned office?

Paul: I would. Right now they're young. They, they both married well. So one has a veterinarian and she's got a big practice. And the other has a tax attorney, so I had a wife that was, had all the kids and she didn't bring any income in, but she was the best mother. She went to high school with every one of the kids. So about three or four times, you know, I'm so busy running around, opening office and working. And she did a really good job of raising the kids. 

Howard: Are you still with her now?

Paul: Oh, forty-three years, yeah, cheaper to keeper. Yeah.

Howard: Cheaper to keeper!

Paul: No, she says that about me. She’s the one with the money. But, I don't think they'll get into an organization like this until they see what it's like to start their own business and maybe sell a business. That's why my son, Jonathan, if does develop this into a three, four million dollar implant practice and somebody wants it then, he'll be more than glad to sell-

Howard: Did you hear your story on the cover of the Wall Street Journal last week about the Orthodontists in Utah that graduated from orthodontic school. One million dollars in debt. Did you see that article?

Paul: I didn't see the article, but that's the truth. That's the truth. Yeah. Our kids are half of that and it's stressful because you got to pay that loan back over like ten or twenty years

Howard: What people don't realize that just as little as ten years ago, I mean dental school was like thirty-five thousand a year, then it exploded the seventy-five to a hundred thousand year. But remember, you know they had their undergraduate debt and then if you were paying hundred thousand a year for dental school, but Ortho is three years, so that's another hundred thousand a year for three years. But then it's accumulating interest. So when he finally walked down the aisle with is as a board as an orthodontist, he was one million dollars in debt. What kind of advice would you give to a kid like that? 

Paul: Become an implant dentist. You know, make more money and it doesn't cost you as much. That's what I would do.

Howard: If some kid was listening to you in dental school, when they were juniors in dental school and they said…

Paul: Ortho implant dentistry, perio, I really would push him towards learning about implants. 

Howard: Why is the grass greener with implants and Ortho?

Paul: It's kind of a special skill set that not many dentists have. A lot of dentists have to send the patient to a periodontist to have it put in, or an oral surgeon. If you can learn how to do the whole Enchilada, like my son does all on four and hybrids, AD does all that. So I mean, his cases will be like twenty-five-

Howard:  Fifty-five thousand an arch. 

Paul: Yeah, exactly. 

Howard: So you know, what's weird about that? So those are all important. I got a bunch of friends in my backyard and do these twenty-five thousand dollar an arch all on four. And on a lot of Fridays they'll do an upper and lower arch. It's a fifty thousand dollar Friday and the average American will buy a new car every five years between sixteen and seventy-six. Mean average price on new car be thirty-three thousand, five hundred. One arch of an all enforced twenty-five full amount is fifty, and it's only about one in twenty dentists that every Friday, they see all their regular stuff Monday through Thursday, then Friday is surgery day and every Friday is a fifteen thousand to fifty thousand dollar case and they'll do it every Friday, fifty Fridays a year their whole career. And then the other nineteen out of twenty dentists will never do one case. The price of a new car, their whole life. So why is that? Talk about that.

Paul: Special training. 

Howard: Because first of all, do you agree with that? With what I just said?

Paul: I absolutely agree with that. I would-like Dr. Mccracken's course. I think it's like twenty-eight thousand dollars, but you actually go and do surgeries because when I took my implant training I just sat in lectures and I watched Dr. Mills do the surgeries and you could not, because you didn't have a license. I'm not talking about myself, but the other doctors, there's like sixty doctors that ranking.

Howard: Ryan, can you find Mccrackin course prosthetics in Alabama. He's in Alabama.

Paul: It's called AIE. He's a prosthodontist.

Howard: Mccracken Prosthodontics in Alabama, and his course is how much?

Paul: I think it's twenty-eight thousand, but he has some entry level courses where you can put in four to six implants and it's like five or six thousand. My son teaches with Dr Mccracken on those in Atlanta. They have everybody comes to Atlanta. They get the lectures. Jonathan lectured with Dr Mccracken.

Howard: So, Mccracken’s luxury in Atlanta, but he's from Alabama?

Paul: Right. They have maybe once or twice or three times a year they come and do it in Atlanta.

Howard: And why would they go to Atlanta? 

Paul: Because Atlanta, no, today their center is in Bessemer, which is kind of in a poor area of Birmingham and they have a clinic called the Foundry Dental Clinic, and it's a wonderful organization. They have donations and so on and and Lutheran medical actually funds the ten residents has now. Jonathan was one of eight residents when he was there. He was the chief resident, and so they have the residents there every day to pick up the suture lines that opened up, you know, from the surgeries that were done on the weekend, you know, the sutures will open or a patient has an emergency and also these ten doctors learn how to do sedation, so they will sedate the patient for you if you take the course and so you can have sedated patients as you're doing the surgery. You'll learn how to do sinus lifts, bone grafting, multiple extractions, surgical extraction. So it's a wonderful course. So become a dentist. Don't go to a hundred thousand dollar a year specialty program, save up twenty-eight thousand dollars, or finance it, and take a course like that. There's a lot of other courses where you can go offshore and do implants in foreign countries too, so that's a good way to do it. 

Howard: Any you recommend?

Paul: Well,  I'm trying to think of some of them. I've been more exposed to Dr. Mccracken's course because he's near Atlanta and then Dr Mills is in Atlanta as well. Dr Mills is not teaching the Maxi course anymore, but the Maxi course is a good course to take and they're all over the country.

Howard: And explain to them about the Maxi course program.

Paul: Okay. The Maxi course is kind of endorsed and sponsored by the American Academy of Implant Dentistry. They actually have won court cases to where once you take the course and you get your certification, you can call yourself an Implant Dentists,

Howard: Oh my God, so that American Academy of implant dentistry aid. And their program is the Maxi course teach you how to do this. The other ones, in Texas, remember this is. Texas is a different state than all the other states and they don't mess around in Texas. This guy calls themselves a specialist, so they, the American Dental Association is a tripartite system, so they're the ABA in Chicago for the country, and they have the state or Dental Association for the state of Texas. Then you have your little. It's a tripartite system. Well, they told him to quit calling themselves, especially because the ADA only recognizes nine, and the guy said, “Well, I am an implant specialist.” And so they had a system and the Texas judge said, the ADA, you're a membership organization, you’re not some government agency, who the hell are you to say you're a specialist and it has this guy, “Are you specialist?” He says, “Yeah, all I do is implants,” it’s case-closed. That was the death. The Ada’s overreaching, caused the death of the specialty. So I know people, and I had been knowing people that have been doing this for thirty years, where they say, “Okay, well I'm not a board certified endodontist, but I'm in a town of eight people in the middle of New Mexico, and the other seven hate molar endo. And I hate doing kids and crowns and veneers and all that.” So they just say, practice limited to endodontics. And they just need their endo, like they were endodontists and board certified specialist. And by the way, some of the biggest legends in endodontics, like the guy who invented thermopylae, Ben Johnson, Tulsa, Oklahoma, Tulsa dental company, he never went to endo school. Probably the smartest one that ever lived was John Mcspadden, in Chattanooga, Tennessee. He never went to endo school. He just said, “I'm just doing endo.” So you're saying come out of dental school and just learn implants?

Paul: Learn implants. And then they are going to probably have specialty programs set up because people are asking to have it, ADA will probably get behind something and have the specialty in implant dentistry.

Howard: Let’s talk about one more thing on that. We talked about, Align technology who owns Invisalign Iterra and they bought 17% of Smile Direct Club. Do you think it's legal? Because I was worried about, okay, I'm going to die. And then I got my grandchildren. So Taylor's five, when she's eighteen, I'm sitting here wondering, is it really going to be cool for her to go to a mall and some beautician, oral scans, and they and they send the impressions to Costa Rica and Ken Taylor get Ortho without an orthodontist ever looking at her?

Paul:  I don't know the answer to legality. 

Howard: That's all right. Is that your girlfriend or your broker?

Paul: No, I sold one of my waterfront lots and that's the guy telling me something, so I'll call them later. So anyways, if you say anything disparaging about Smile Club Direct, they will sue you. They will drag you into court.

Howard: Smile Direct Club: disparaging.

Paul: Yes. Don't say anything. No, don't say anything. Don't say anything, you know, because I think they're fighting it out right now with the state boards on whether this is legal, but they supposedly have orthodontists on staff that monitor every case. So, I don't know how you can do that, but that's fine.

Howard: That's teledentistry.

Paul: Well, teledentistry is going to be the future and telemedicine is going to be the future. So maybe companies like this need to be out there and test the waters and then it'll get regulated to protect the public. But somebody has got to be the pioneer. That's the guy with the arrows in his bag.

Howard: Alright. So many dentists think they’re a legend. And I'm like, “Okay, so how many arrows have been shot in your back for what reasons?” “Oh, I've never been sued and no one's ever shot an arrow in my back.” Then you're not a pioneer. Dude, these are monkeys. If you climb the tree to the highest of the tree, you'll get hit by all the coconuts and bananas. And if you're not getting the arrows shot in your back, you're not saying anything exactly revolutionary. And what they're doing, this telemedicine. It's revolutionary. I mean it's the internet, it's the scanners, it's different countries. So where do you think you'll end up, where's your prediction ten years from now?

Paul: Ten years from now. That's about the time I may retire. Maybe. 

Howard: Well, here's, here's my prediction is that the most confusing thing is when you're little, you think you live in the United States of America and when you live around the world, do you think that the United States of America is this country, and it's no more of a country in the EU and in the EU, you don't compare Germany to Greece. You don't compare Portugal to Sweden to Denmark. It's like, the EU is countries flying their flag. So what will happen in the United States is there's fifty states, there's fifty different dental societies, there's fifty different attorney generals and they will - one state will end up being the Mcdonald's. One will be the In and Out Burger One, Burger King, Wendy's, and that's one of the secret sauces of America is that if it was one country and the feds made you do everything one way well, how would you know which was the best fast food restaurant? That's why I hate the Department of Education. The Department of Education is like trying to tell American schools they all have to be a Mcdonald's. And you know what? Some states need to Mcdonald's, some need a Burger King, some need a Wendy's, some need a Sonic drive in, some need an In and Out Burger, some need a Whataburger, and then watching other states trying to do at different things and you let that roll out for ten years. Then you sit back and say, “We know what we got. We got fifty states, ten of them are doing this differently, but you know what it looks like? The tradeoff is here, so the states that do this. This is what the get, because nothing's right or wrong. 

Paul: It’s a tradeoff. Hygienists having their own practices. I mean that's now common. Hygienists giving shots, giving injections. I loved it when I was doing my implant work as an orthodontist. I might have a TAD planned patient over here and I'd have my hygienist. “Would you do a little infiltration for me,” so I wouldn't have to leave the room.

Howard: But see it's the same when when you’re our age, just keep seeing the- do you remember what it was like when they try to get hygienists passed? Do you remember how the redneck conservative hillbillies are like, “Oh my God, no, what you're going to get, you're a license or to clean too? That's my sacred sovereign perfect.” They fought hygienists like hygienists were Hitler’s twin sister, twin sister, and now none of them want to go back and do their own cleaning, all hygienists do it, and now here's the same rodeo again. Dental therapists, what do they do? They're going to do fillings. Well, most all my friends don't want to ever do a filling again. They so now-

Paul: So, they do so we can concentrate on implants. 

Howard: So all these dental therapists that I've seen graduates so far. First of all, the dentist says, “Oh yeah, this is great, man. Now I got rooms one and two is a dental hygienist, rooms three and four is dental therapist.” So, you say, “What’s the difference? Well, the hygienists getting forty dollars an hour, does the cleanings and all that stuff. The dental therapists go in there and numb, prep all the fillings, do all the fillings. They're paying them both the same wages, about forty bucks an hour, and the hygienist is getting paid forty, doing a fifty-five dollar cleaning the dental therapist is getting paid forty doing a hundred and twenty-five dollar filling and a lot of them are doing two in an hour. I can't find any dentist that doesn't like dental therapists, but fifty state dental societies all think that it's the end of dentistry. What would you rather be in there doing a- and by the way, I want to tell you one of the hardest hours in dentistry is when you walk into a room and you got to MOD on two, three, four, and five. You're like, are you shitting me? I mean, that's an hour, and when you're done, I need a nap. I'm fifty-five. I need an nap for that. And, who’s fighting that all? All my homies.

Paul: Do you know how long it takes to put one of these TAD plants in? 

Howard: How long?

Paul: Two minutes. 

Howard: And how much does it cost? What will the fee be?

Paul: Well, I've been working with the fee will be about fifteen hundred dollars with the crown and the implant, but that's all the prosthetic. 

Howard: But see, they don’t want to do that. They want to ban hygienists and dental therapists. They want to do cleanings all morning and MOD direct fillings all afternoon.

Paul: Well, I’ve seen centers like the Orthodontic Care centers of America where the prices were cheaper so that the public could afford it. I'd like to see that in implant dentistry sooner than later because right now it's kind of an elite specialty.

Howard: Well, let's talk about that. So how many countries have you been lectured and around the world? 

Paul: Not as many as you. If you ever have an extra seat on your jet I'll go with you.

Howard: No, I'll go with you. 

Paul: Six, maybe six or eight countries. Yeah. 

Howard: Okay. In those six or eight countries? Koreans. Three out of four general dentists placed in [inaudible - 00:55:03] Germany, Brazil. Portugal. I mean you almost-and I'm like, well, which countries at the bottom of the list. And by the way, if you want to know this kind of, they had a lot of people say, “How or where did you hear that? Or when did you learn that?” Dude, these companies are publicly traded. Invisalign is publicly traded. You buy one share of any of these dental companies, Strauman, who owns Nobel Biocare and implants? Danaher. These are all publicly traded. You buy one share of stock, they have to send you the ten Q, quarterly, every quarter. The 10k annual report and the data is mesmerizing. It's like my favorite letter of the year is Warren Buffett's Berkshire hathaway letter. And I don't know if I can say that anymore because now Jamie Dimon has an amazing letter too. But, one of the things that Strommen stock is trading so well is because if America caught up to the median average implant placed of just Korea, Germany and Brazil, all these implant companies will be doing three or four times the volume. So my question to you is; why are American general dentists at the bottom of the barrel? Why is implant penetration amongst the three hundred and twenty-five million American citizens implants for a hundred thousand almost the lowest. You almost got to developing nation to do that well.

Paul: Regulation. What is trump doing now? He's taking regulations off and the economy is booming. If we could take some of the regulations off of dentistry, you have so tightly monitored, like the FDA trying to get something approved, now that they're loosening up.

Howard: Oh, don't start on the FDA with me, but you realize this house, you know what, when I bought this house, you know why I bought the house? Because an American who had paid her taxes or whole life had a brain cancer and American pharmaceutical had a cure or a treatment, but the FDA didn't approve it for American citizens. So, she sold this house, took her money to Scandinavia, where she had to go finish the rest of her life. And, she had to sell this and buy a home in Scandinavia. Yeah, because she was in America. And it's like, well, I understand that the FDA-

Paul: For the health?

Howard: Well, no, she couldn't buy, she couldn't get the only drug for her brain cancer. And the FDA said, no, it's, it's under a study. And then she said, well, they're selling it in Switzerland. “Oh yeah. But this is not Switzerland.” So she had to move, she had to sell this house to me, and so it's always the governments. Okay. I understand, if you say, “Hey Howard, this drug isn't FDA approved.” “Okay, I get it, but I'm the one dying of cancer, not you. I want to try it anyway.” “Oh No. Oh No, no, no.” I mean, what is wrong with these people?

Paul: We think that everybody is so backward and were so great in the USA. I mean when I went to Colombia, Bogota, they had a 3D imaging before many of us did, we started buying their machines a little cheaper than we were buying our machines. They have so much experience. They go out into the Pueblos and work on the, every year when a dental student graduates from a school in Columbia, they have to give one year back to the government and go out and work on the people. We should have things like that. In Germany, they're are amazing over there with their technology. The Israelis, they're fantastic. We think we're the best in the world.

Howard: American government says, “You people are dumb and when you retire you have social security. But we, the government, were smart so we will make decisions for you. And we're retired. We have social security and the government pension,” so they double dip on the pension and they're never there. They're dinda like dental insurance companies. Dental insurance companies aren't helping. They’re trying to control you. They're saying, “Well, we'll only pay you a hundred dollars to this filling and nobody can charge more. And if they charge more, they're out of network.” The government's not saying, “I want to help you. This drug you're trying is not FDA approved. It's brand new.” And then I can sit here and say, “Well, I have terminal brain cancer, and I'm down to, you know, Crystal's in Sedona or this American made pharmaceutical this guy has spent his life doing this. I want to try it.” And then think how much that speeds up your research because instead of doing research on rats and monkeys and mice and rabbits who don't have our DNA, I mean, I found out three days ago that I'm actually not a chimpanzee and I'm not a mouse and so why? But I draw the line at violence when she has to leave the country to get a drug from an American made pharmacy. I mean, I think that's repulsive.

Paul: So that is probably the reason why we're not as progressive as some of the other countries, but we can learn from them. I belong to an organization, Dental XP. Are you familiar with them?

Howard: That’s Salma, Ron Goldstein, 

Paul: Yeah, Ronnie Goldstein and Solema the Solema brothers.

Howard: Solema brothers,  Ronald Goldstein. And who was the other one? 

Paul: David Gardner. 

Howard: I love all three of those guys. 

Paul: Great guys. Ronnie Goldstein was the first cosmetic dentist I ever went to when I just got out of dental school, moved to Atlanta to teach at Emory. 

Howard: How many Salama brothers are there?

Paul:  There's two. No, no. There's three; Eddie Salama runs the Dental XP, they have a great series of lectures and people from all over the country come in and of course you know Christian Coachman. 

Howard: I've gone in his courses in Atlanta. 

Paul: Coachman?

Howard: No, Eddie Salama, Goldstein Garber, they're excellent. 

Paul: Then coachman was, Christian Coachman. He has the smile design software and you want to see what the universe result out of San Paolo. He’s out of Brazil, his father I think was a lab tech. 

Howard: His father, are you kidding me? There's thirty-five people in his pedigree. And big Brazilian Portuguese families, but there's thirty-five people in his family tree that are dentists, orthodontists, hygienists, assistants, lab techs, lab. It's, it's an amazing family. 

Paul: He is a rock star presenter. Whenever he comes, he has like an entourage and I was on a program, he was there and I was on a program and I was talking to him in the hallway and he said, “Well, I'm sorry, I don't have much time to talk. I got to go catch a plane. I'm going to either Brazil or Europe or Africa.”

Howard: So when I lectured with him at New York City, he was on a one year tour where he was going to go home, he was going to go home like three times in that year for like, I mean, it's crazy. 

Paul: Have you seen some of their videos where they make them in Romania and they do the makeup and they had these beautiful women that their teeth are kind of like Yucky and then they do the smile design on them and then they do the rest of the restoration. When I give my lectures, I get some of those videos to show what's possible and there, that's good marketing. They're doing that in other countries. We should be doing it here too. And I'm sure some of the doctors are doing it because he has a good following here in the US too.

Howard: Every country, every country. 

Paul: And he started with Ronnie Goldstein's practice. 

Howard: Right? And then the other cosmetic dentists, Ryan, that Mike Apa, is it Mike Apa? Rosenthal group. Oh my God. So I had to follow that guy. In, what was it Cambodia, Cambodia or Malaysia? Indonesia. It was where? Negan, Indonesia. Oh my God. I mean it was like, it was, you'd never want to follow that guy in M and A’s. I mean it was just like they, they clapped for like fifteen, twenty minutes, and he had to stand there because in Asia every single dentist will have to get a selfie with you. Yeah, I mean that the after the lecture entourage for Apa was an hour.

Paul: Well, another up and coming guy, Chris Chang, he's in Taiwan.

Howard: We’ve had these guys on the show.

Paul: He is awesome. 

Howard: With bone screws.

Paul: He has his own bone screw. Yeah.

Howard: So just for the kids who don't know what, what is the to implant and the bone screw?

Paul: I thought you'd never ask. Let me show you. This is a bone screw that is used like a TAD right here. See how small it is? 

Howard: These from a TAD, TAD stands for?

Paul: A Temporary Anchor Device. Okay. Now actually I was going to call my TAD plant BAD, B-A-D; a bone anchored device, but I don't want to call it bad cause I won't sell any of them. So see how small that is, and then the TAD, I think I showed you, you should have it right here. It's a little bigger, but most TADS are one piece, the one that Dr Chang talks about is one piece and then also his is designed with a square hicks kind of for getting it in and out. And then he's really smart, because he puts them into the buckles shelf in the Zygomatic area instead of inner radicular and I've always had put mine in that way. I was wondering why. And he's the one that says you, it's a little safer to do it that way and he's done a lot in implant dentistry and he has a group that he has lots of surgeries and his videos are awesome and he's on Youtube. 

Howard: So let me ask a final question because we've gotten way over an hour; why do so many orthodontists and oral surgeons in America fixed so many classes and class threes with surgeries and Le Fort fractures surgeries? When in Taiwan, this guy does it  all day long without any surgery? Do you agree with that assessment or not?

Paul: Well, yes and no. 

Howard: Do you agree? Do you think that Americans use more orthognathic surgery than the Taiwanese?

Paul: Well, probably yes. This is the typical case for ortho veneers, but this is something that I've been doing for years called the MEAW technique, right? Multi-Loop Edgewise Archwire. And what you do is you bend up the wires that look like this and it closes the bite down. He wears some rubber bands and the wires- This was invented by Dr. Kim, in Asia. I think it was Korea. I think he's Korean. Sato Kim, or maybe it's Sato and Kim. So if orthodontists know how a bend wire- The younger orthodontists don't bend wire anymore because everything is preformed. Everything's this high-tech metal now. We had to bend wire back in the old days. And so if you knew this technique here, this is a surgical case, open bite. It was treated with MEAW. My son, who's not even an orthodontist, Jonathan sent me a case the other day. In three months he closed the bite down and he used the MEAW. He bent the MEAW up. See, my boys worked for me as dental assistants, since they were nine or ten. They'd been in my office and so when they got out of dental school or they were on summer break or whatever, they're bending wire, they're treating patients under me and it was so nice that I could sit and train them. Every day I get a text or something from one of the boys. “Dad, what would you do for this case?” That's why I'm going to live another forty-seven years.

Howard: Ryan, what podcast was the MEAW technique? We just had the orthodontist. Where was she from? What country?

Ryan: MEAW technique?

Howard: The MEAW. M-E-A-W. What was the female orthodontists we just did about the…

Ryan: Monica Casadei?

Howard: Yeah. From where?

Ryan: Italy.

Howard: She's a MEAW legend in Italy. But see, that's another classic example why you don't want government regulation like the Department of Education because these orthodontic surgery cases that Americans do, they're doing it with bone screws in Taiwan, in Italy and with the MEAW technique.

Paul: But we're doing it with MEAW in the US too, because I've done many of these cases like 


Howard: And when the government tells you that everybody has to have it done this way… I saw the funniest meme yesterday. It was BMW's, every two-seat car from 1950 to 2015 and then above it, the Russian, their car every year. So for the Russian car, every year it was the same for fifty years, and the BMW just looked like it evolved from a chimpanzee to a homosapien, and when you do regulation, you never know what you have. You'll see that in France. France had a nuclear regulatory agency when they only had one approved reactor. The United States, every different utility company built a different reactor, well, guess what? After thirty, forty, fifty years after that, guess which industry is more thriving and which industry knows which reactors worked better for which reasons? So there's diversity. That's even how evolution works. Now you have twenty different kids with different phenotypes and you see which one survives.

Paul: Well, I think that dental students should be a CE junkie and should go to everything they can go to. They can go ahead and call on the the older dentist in the neighborhood and get to know somebody that can mentor them. Our association has a mentorship for orthodontists that want to mentor. We were listed on the site.

Howard: Is this is the AAID?

Paul: This is the AAO, the American Association of Orthodontists. So I have like three or four students.

Howard: So the AAO has a mentorship program for general dentists?

Paul: No, no, it's for orthodontists. But I mean, I'm talking about general dentistry. If you can do it in general dentistry, you could have a mentorship program. You put it together. That was really just what you're doing. That's your business. You're a mentor, you're teaching these kids the business.

Howard: And you know what he said? Go across the street. Your mentor lives across street. If you have to get an airplane to fly to your mentor, I don't think he's your mentor. Find some guy. You're twenty-five, you're thirty, you're thirty-five. How old are you?

Paul: Seventy four.

Howard: Why do you have to get on Southwest Airlines and fly three hundred bucks to go get a mentor? And that mentor is not going to be there…

Paul: He’s right across the street or join the dental society.

Howard: And when you got upset patients and something goes south, your patient’s not going to fly to your mentor.

Paul: Start a study club. Those are things like the Seattle Study Club, just blew up and took off and those things are available and they don't cost the money to become- And learn the special skill set; implant dentistry. Go to the implant meetings too, they're fantastic, and they're international. I mean we have people from all over the world that come in and lecture.


Howard: Well tell Mark Cooper I said hi. So where is this meeting at?

Paul: It's at the JW Marriott.

Howard: Is that in Scottsdale? 

Paul: I think so. I don't know the city. I think it's just like a one mile from the border of Scottsdale and that's what the lady was-

Howard: Tell him I said hello, and I want to thank you so much for coming by the house and talk to my homies.

Paul: My pleasure. It’s an honor to meet the legend. Legends here.

Howard: And Ryan is a legend. I am the father of the Ryan legend but hey, if you ever want to build an online CE course, we've put up four hundred courses on Dentaltown and they're coming up on a million views.

Paul: Wow.

Howard: So if you really want to take everything you've learned from ‘72 to 2018… And the millennials like one-hour segments; it's kind of overwhelming to think, “Okay. I'm going to go to an eight-hour course on Friday,” let alone, “I'm going to have to fly across the country on a two-day course and it's four grand.” But when you sit there and say, “Goddamn, I'm not doing nothing. It's Saturday afternoon. I just barbecued a hot dog. I'm going to watch this hour course.” So the hour, hour and a half courses, they're not overwhelming-

Paul: But an hour is better. The sweet spot.

Howard: An hour is better, and when they listen to something for eight hours, their brain starts- But thank you so much for coming by.

Paul: My pleasure.

Howard: All right buddy.

Paul: Thank you.

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