Episode Transcript
[00:05 - 00:29] Rob: Welcome back to the Evolution of Dental Podcast, brought to you by Evolution Dental Science. We share the stories of the people and the technology shaping the world of dentistry. I'm your host, Rob Norton, today's guest helped reshape the world of full arch restorations. His inventions and his teaching techniques have redefined how we look at full arch dentistry. Doctor Jonathan Abenaim, welcome to the podcast. How are you?
[00:29 - 00:34] Jonathan: Hey, thank you so much for having me. And what a nice intro that was. I appreciate it.
[00:35 - 00:44] Rob: So Doctor Abenaim, did you just wake up one day and decide you wanted to be a dentist? What got you into dentistry? What made you want to pursue implants and full arch restorations?
[00:44 - 01:58] Jonathan: All right, well, Great question. I'm still asking myself that after all these years, 20 plus years and counting. I didn't think I was going to be a dentist back then. I went to college in 2001. I was 17 years old, and I loved computers. And I said, you know what? I'm going to go into computer science. And when you get to college, you realize that computer science is not what you really think it is as a kid. And you're like, forget it. I don't want to do computer science. Let me pick the next boring thing. And I became a biology major. Then I said, you know what? Let me be a dentist. Every mom's dream is to have a kid that's a doctor back then, and my dream was to be a periodontist and a prosthodontist. And although I don't have those actual titles, I want to pros-residency. But that's essentially what an implantologist is today. You know, it's being able to take every discipline in dentistry from massive, I would say, ADHD, to being able to see every little thing that goes on in dentistry and put it together. And for me, again, that wasn't enough. The restorative wasn't enough, then the surgery wasn't enough. And then I added the lab into it, and then from the lab I was able to connect all three. And that led to me inventing all of these things that I have in my portfolio.
[01:59 - 02:03] Rob: That's a fascinating journey. At what point did you decide to try to incorporate a lab into your workflow?
[02:03 - 06:30] Jonathan: Yeah. So, you know, one of the things is that, I've been a dentist since 2005, but I would say probably 2015, ten years after, I realized that labs and dentists, they just. Although they're the same, they're in the same discipline. They're in the same profession. They just speak two completely different languages. But more importantly, it's like their mindsets are completely different. And my dream really was to be able to fix that, to be able to teach each other the language. And, I went from trying to partner with labs to be able to make that work, to having an in-house lab technician. And maybe it's a failure on my part as a leader, but I just couldn't make it work. It just didn't work for me. And I know there's a lot of dentists that [make it] works perfectly and Evolve is one of the top labs out there. And I could tell you that in 2015-16, when I gave my first course and everybody told me that what I was doing was impossible and it wasn't real, and whether it was a lab technician threatening my life or dentists saying that I doctored a lot of the work that I was creating, the people that were there with me from the beginning was your leader Andy, and Josh. It's almost interesting that they saw that this was the future. This is before anybody was doing implant digital dentistry. Nobody was doing it. I was the only one that said we can make it work. And everybody said, no, you have to stick to analog. You need a plaster cast, you need a verification jig. You need all this stuff. And everybody that's lecturing today, you can see they- most of them have been through my teachings, through both sorts of my lectures or they've, you know, bootlegged my lectures or copied them. But more importantly, Andy and Josh said, this is the future, and we need to get educated. And a lot of the concepts that are out there, whether it's intraoral photogrammetry, whether it's the ways that they do scan paths. I was talking about this back in 2017, 2018. And I really believed that it was going to work. So, essentially, I became myself a self-taught dental technician. You know, we fabricate, we design, and when I say we, it's me. I design every single case that goes out. I mill every single case. I taught my assistants because sometimes I'm lazy or I'm not feeling it to layer porcelain because, you know, layering porcelain, it's… it’s like doing a painting. If you're in a bad mood, it's not going to come out well, and you need to be able to step away from that to be like, okay, now it's time to paint, or now it's not time to paint. And, to be able to have some assistants to be able to do that for me. It's just really great because I can always see that if I layer ceramic when I'm not in a good mood, it just doesn't come out the way I want it to. So that's sort of like my evolution that was there. And once we started fabricating these things and I said, wow, these scan bodies that are out for implant companies are just a total disaster. They make no sense whatsoever the way that we're using Ti-Bases, tiny little titanium sleeves to hold onto these massive zirconia prostheses. That also doesn't make any sense. And our bars back in 2016, 2017, we couldn't fabricate them fast, accurately, or even, cost efficiently like we can do today. So that just wasn't in the game. The game was- gold was too expensive so we brought zirconia in. Zirconia was strong, but it's really a poor material even still today. But we figured out that we need to do Ti-Bases. Now I can’t tell you how many times where we had a delivery and I asked my team, hey, did you cement the tie Ti-Bases? And they’re like, oh, we forgot. And they would rush to cement the Ti-Bases. I'd go to place it in the mouth and boom, the Ti-Base would explode. Why? Because it wasn't cemented correctly, it wasn't put in correctly. There was a little bit of play. And then I just said, this is ridiculous. We need to go back to the drawing board. And this is when I was reintroduced into the implant game: the Ti-Base-less restoration. Anybody who tells you they did it before me, the only person or the only company that did it was Nobel. And they failed. And in the early 2000’s with Procera, and I brought that back in. But in general that's how everything came about. And, we've had unbelievable success with the screw. The doctors that use it love it! And just the education to be able to understand what to use, when to use is super important. A carpenter would never use the same screw for wood, for metal or plastic. It's all different. And we should do the same thing when we do restorations.
[06:30 - 06:52] Rob: I really like what you said about a carpenter selecting a different kind of screw for each unique material. You wouldn't use the same screw on wood as you would with metal. So what was your invention process like? What took you from a chairside practicing dentist to literally inventing a new type of screw and a new way of retaining full arch restorations in the mouth?
[06:52 - 10:13] Jonathan: Yeah. So what's interesting is that if you look at, historically the way that, implant products or any dental products historically came out, essentially of big wigs, big, big companies would have a bunch of people that are, again- speak a completely different language, and they'd go ahead and they'd have something come out and the dentist would be like, oh, this is kind of cool. And then when they used it wasn't that great, but that's all we had. Like, think about it. Why is it that anesthetic tastes horrible? Been all these years, it tastes horrible! Like patients complain every single day, yeah, we don't have an anesthetic that tastes well. It’s just an example of how, as dentists, we're at the mercy of huge companies. And I would say that probably in the past five years, because of the way manufacturing is, because of the internet, because of the access to so much more knowledge out there. Small companies or small individuals have the ability to really invent things that are needed and produce them. And, we see that. We see that every single day today. So, because of that ability, I said, okay, well, everybody thought that if they would do the Ti-Based skip, which I would say this is Nobel. Nobel thought that if they're going to skip the Ti-Base in the early 2000s with their Procera system, they're going to control the milling. You had to send everything to Mahwah, New Jersey, and we're going to mill it for you so that you don't make a mistake. Because, again, mills were not available like they are today. And, instead of inventing a new screw for this, we're just going to take the screw that goes in the titanium sleeve, and we're going to put it inside zirconia. That doesn't work that way. The seat needs to be different. The angles need to be different. Everything about it needed to be different. And that's why it failed then. So I really looked at that and I said, what did they do that was wrong? Like, why are we using cement? Like, think about it, we would never prep a tooth that's 3-4-5mm high, and put a crown that's 25mm tall on it and expect it to last. Yet we were doing this to implants all day long with Ti-Bases. All day long! And with the advent of zirconia, we were going away from the wrapped acrylic restoration. Why did we think this would work? And people say, oh, it works, you won't have any issues. Yeah, in an ideal situation, it can work, you know, but long term, with it out in the wild where things are not ideal, where the implants are not always placed correctly, the impressions are not perfect, where the milling is not perfect, all of these things because we have to be able to, get a timeline, things get cut, and then we have issues. So I said to myself, okay, how can I create it for myself? Because I need it for my own patients. And I couldn't count on any companies to be able to do this. Companies, whenever you speak to them, they steal from you because they're bigger and badder than you are. And, that's really what happened. And then you saw all the different guys started to invent things, and that was really my inspiration. The Powerball screw really came after. The real first- invention that I did was to be able to have a scan body that allows an intraoral scanner to scan implants. That was really my first invention. The screw came after that, right? Because we had Ti-Bases, but it just wasn't right. But in order to get the Ti-Bases, we needed to be able to get an impression. The real problem that I saw was that I was not taking open-tray impressions, bringing the patient back, taking out the prostheses, doing conversion prostheses, trying to cut out solder bars, send it back to the lab, wait another two weeks, put it back together- It wasn’t worth it! I was like, If I'm going to do this for another 20-30 years, I'm not doing this for the rest of my life. I'm not cutting, but I'm not cutting metal. I'm not using GC resin paper. I mean, it's impossible. You couldn't do cases like we do them as fast today, and patients were like forget I'm not dealing with this-
[10:13 - 10:15] Rob: Sounds like a big loss of resources and money.
[10:15-10:16] Jonathan: Yes, it’s too much!
[10:16 - 10:20] Rob: Everyone's rescheduling comes in two, three, 4 or 5 visits. That’s not an efficient workflow at all.
[10:20 - 11:21] Jonathan: And a lot of apologizing. You know, it's a lot of apologizing. And I said to myself, I cannot apologize because the system is broken. Like I didn't do anything wrong. But if I'm part of the system, it's also my fault. So I figured I needed to change it. And, look at where we are today. From this mind, you know, my lectures always started, “The mind is like a parachute works best like it's open” because what happens is, and all the people that have labs, you know, two famous prosthodontists that had labs, I remember they were sitting like this in my lecture. They're big-shot prosthodontists sitting like this like you're a general dentist. You're not going to tell us that analog doesn't work. And now that's all they speak about. And, I'm glad that we were able to change people's minds, people's lives, with this. And dentists have the ability to be more productive, more successful, more fulfilled in their, in their dentistry. And, yeah, it's awesome.
[11:21 - 11:42] Rob: And you've seen the evolution of the intraoral scanners as well as the introduction of photogrammetry. I'd love to hear your opinions and thoughts on both where we are with 3D intraoral scanning, as well as photogrammetry, and where each of these things has their strengths, weaknesses, and best applications in the industry today.
[11:42 - 12:15] Jonathan: So yeah. So it's very interesting that you said this whole thing about intraoral scanners. We're actually in a massive evolution right now with intraoral scanners. So I was a massive proponent of not needing photogrammetry for many years. Specifically in the beginning. Because I really felt and I still feel that photogrammetry brings in a lot of errors. And what people don't realize is that photogrammetry only gives you the position of the implants. When I say the position of the implants it’s the position of the implants, period. End.
[12:15 - 12:17] Rob: That's right. It's just a matrix.
[12:18 - 12:19] Jonathan: That's it.
[12:21 - 12:21] Rob: Nothing else, no bite.
[12:21 - 12:23] Jonathan: The problem is the bite.
[12:23 - 12:24] Rob: Yep.
[12:25 - 14:24] Jonathan: Now when- when I invented my scan bodies, we were able to get everything in one. So in the world of intraoral scanners: Trios3 did really, really, really, really well. The software was very elementary, and didn't have a lot of algorithms behind it. It was just, take a picture. If the picture isn't right, you would see it on the screen. It'd be all fuzzy. You delete it and you start again. Any company can produce a scanner for $1,500-2,000. But the key to the game is all software. So today, our workflow actually, includes a backup plan, which is photogrammetry to check, but there's so many errors and I see it every single day that- come up, that the elementary guy will never see it if he doesn't know or he or she doesn't know what they're looking for. So I always tell people, be educated. Understand what you're doing, how you're doing it, so you can double check yourself before the designer who spends an hour designing your case. You spend a half an hour printing it, another 20 minutes coloring it, and then you go to the patient's mouth and it's off because nobody likes a bite that's off. Because you know what happens? Dentists and labs start speaking a different language and that different language is this: your fault? My fault? Your fault, my fault. And that's where everything can blow up and businesses can get hurt and personalities can start coming out. So I really think that people really need to be mindful of this, and the companies need to be responsible about the way they release things. And be aware of the errors that they're introducing. I think that implant companies should come out with just an implant scanner. Just a tooth scanner. And don't change, don't change anything, just leave it. Once we know that the accuracy is there, once we know the algorithm is correct, please leave it.
[14:25 - 15:56] Rob: I've seen what you're talking about where the scanner companies are. I mean, they're in the business of selling scanners or in the case of 3shape, they're the software company who is also selling hardware, and they need to keep up. And as other scanner companies come out with new AI features, new integrations, there's other players who I will not throw under the bus by mentioning them, but I've seen examples of exactly where you're talking about where they'll take the data that was reasonably accurate, acquired out of the mouth, and then they'll patch it together so that it looks better as opposed to perform better. Bottom line, the lab would prefer to get the unedited data in the first place, because you can split it together in exocad a whole lot better than any scan software's ever going to patch the holes. And most labs are using exocad these days anyway. And if you're not, please please subscribe and find out more about exocad. That said, these scans are not- some of the scanners, not all of them, I'd say. But a lot of the scanners, they're in the business of selling scanners, and they're trying to facilitate that by creating scans that look better but aren't actually performing better. So I think that's a good point. And that's also a good segue to another question I have. So you said you have created three iterations, 1.0, 2.0 and 3.0, the Powerball Screw. Can you talk us through what the differences between the three are, what inspired the invention of new screws, and how we ended up there?
[15:56 - 16:01] Jonathan: Yes. So we have, with the three iterations of my screw… Come here, buddy!
[16:04 - 16:05] Rob: Aww, look at him! That's adorable!
[16:06 - 17:50] Jonathan: Alright. So the three iterations of my screw. So again, as with anything, I always look at problems, and I always want to try to make it better. I can tell you that my first screw, Powerball 1.0, is the one that sells the most. It's the one that, I tell my customers, upgrade to 2.0, upgrade to 3.0 and they’re like, we have no problems with one. We don't want to change. And dentists are creatures of habit because they don't want to. They're scared to add new things. So Powerball 1.0 is a workhorse. It's sort of this screw that works everywhere, you know? And I would say it works in 99% of the patients. You have no issues. You can use it everywhere. When it comes to those other patients where you need more things to happen. That's why I came into 2.0. So what we were finding is as the industry continued, we saw that low cost or budget friendly solutions needed to be out there. And those budget friendly solutions sometimes included a long term printed restoration, you know, like they or the doctor would do the surgery and then, the patient wasn't able to upgrade to zirconia or finish the case in zirconia. So they stayed in their printed temporary longer. So what I found was that it wasn't that the temporary material wasn't strong enough. People kept making the material stronger and stronger and stronger. That wasn't the problem. The reason the restorations broke was because the screws were getting loose, and the reason the screws were getting loose is because the material innately flexes. And when material flexes under load, screws get loose. It doesn't matter what you have in there. So whatever-
[17:50 - 17:59] Rob: Like your earlier observation, you said a carpenter wouldn't use the same screw for every kind of material. You wouldn't use a machine screw in a block of wood, for example, right?
[18:01 - 21:13] Jonathan: That's correct. And that's what people are doing. You know, people sell just one screw, and it's basically just a reiteration of my screw. By getting around my patent. You know, they’re like, oh, we invented a screw. We'll put some name of a tornado on it or some name of an animal on it, like it's like, dude, you're just copying what I did. Like, be innovative. Like, I don't have a problem with competition. It's great. For me, I don't think we have competition. It's just that, like, be innovative. Don't just do a watered down version and try to say that because my access hole is 2.5mm and yours is 2.2mm, do those 300 microns actually make a difference? It really doesn't. And let me tell you something. When a screw is broken and you need to get it out, you want to be able to see you make that access hole bigger anyhow. So for 300 microns, you're telling me that your screw is superior? That’s not true. Why would I want a screw that is smaller when I'm bolting in teeth that are massive, I can make my screws smaller. Why wouldn't I make it smaller? It's a click of a button. I can do it in a second. I invented the screw before any of these people. So it's not about, you know, like, I don't want anybody else. I would love other people to do something better than me, but when it's just a watered down version of what I have, then what's the point? So let's get back to it. When we were talking about, these screws in terms of what was going on, I felt that as the resin started to flex because it was in there longer than it's supposed to, which is that anywhere between 2 and 4 weeks, people are getting restorations that were breaking and they’re like, oh the resin isn't strong enough. It's not true. The resin is strong as long as it's screwed down the second the screw gets loose, whether it's zirconia, whether it's PMMA, whether it's printed, it's going to break. So I invented Powerball 2.0 and Powerball 2.0 is exactly the same as 1.0. It just has a second retentive feature, sort of like this, a Morse taper, or this cone that allows it to engage the restoration by not only clamping down with the head of the Powerball, but actually, sort of like wedging itself into the resin restoration to be able to do that. So that was invented really for long term resin. And then we thought that, okay, it's going to be great for zirconia. So I personally use it for full zirconia, for long term resin, long term PMMA. So essentially my restorations were like Graphenano restorations. We wanted to have less flex so we used Powerball 2.0. And for full zirconia, we wanted that extra umph there to be able to make sure that the screw didn't get loose. Again. We didn't have screw loosening issues. It's just the way that the market was going. People were pushing these things further and further and further with poor restoration, poor occlusion, less reduction, things that labs have to jump around. But they needed that extra help so that they wouldn't have to remake the restoration. So that was really Powerball 1.0 and 2.0. And that's where- that was my line. We're just going for that for a very long time. If you wanted to upgrade to do 2.0, it involved a little bit more sophistication in your milling. We'd have to actually add an extra tool called the T-Cutter to be able to mill that cone correctly-
[21:13 - 21:31] Rob: For those of you who don't know, a T-Cutter is a flat nosed milling tool as opposed to a round nose milling tool or bur. And that flat nose allows it to cut 90 degree geometric shapes into a restoration. Whereas a ball nose tool can't do that because it's, well, rounded in the end. Sorry for interrupting!
[21:31 - 25:27] Jonathan: No, I appreciate it! So a lot of the mills that are what we call “closed” don't really have that option to be able to do that. So people stick with 1.0 because you can just use the regular 2mm,1mm, and 0.6mm regular tools like we talked about. Now the market starts to change again. And we're starting to see these full zirconia restorations starting to explode. Right. And these are 2-3 years down the road. And we're starting to learn why they're exploding. Whether it's these fractures, whether they're just too tall. We were baking them too long. And we don't see the fracture till 2-3 years later, and then we're like, okay, we need something stronger. And because titanium mills are much more available and much more affordable, we start to make our way back to titanium bars. Now, I'm not going to go back and start using these tiny little screws that keep on stripping.So I said, I need to invent a titanium screw, fo r a titanium bar, for these types of restorations. Now, originally we started using Powerball 2.0, which was amazing. It was a friction fit inside metal. Unbelievable! I loved it, but because it's not enough for me, I said, why wouldn't I invent something that has a real double locking mechanism, like a full double locking mechanism? That means that the Powerball screw clamps its way in by seeding the restoration. The Powerball Screw is locked into not only the multi unit, but it's also locked into the titanium bar. That is never going to get loose. And everybody said to me, it is impossible. You will never get the timing right, because you have to time the part in the titanium, and you have to time the part inside the multi unit. If anybody knows me, whenever you tell Jonathan Abenaim it's not possible. I don't sleep until it's possible. So I started my quest. I started studying pitch threads. I started studying pitch thickness, pitch width. And I started working with the cam companies, HyperDENT and MillBox to really figure out how I can make this happen? I spoke to the screw manufacturers. I was learning to deal with implants. I just spoke to screw engineers, explain to me what a pitch thread is. Explain to me how [I] can make this happen? And how does it have to start? And that's how Powerball 3.0 came out. So it will always engage the screw, the multi unit, and the titanium. So now you have a restoration that essentially will never get loose. And whenever you create something strong, what happens? The weakest point starts to fail. So what we will start to see is- that if labs or dentists or whoever is putting these two things together, if you're not meticulous about how you prepare your zirconia, prepare your bar and cement them together, they will bond. Because screw loosening is a thing of the past when it comes to titanium. Now, if you have an amazing lab and you have an amazing screw and an amazing mill and you put everything together and that's never getting loosened, never going to fall apart. What we're now starting to see is all the errors that the patient created. We're now seeing it in biology. We now start to see implants getting overloaded because these things are not getting loose. So the force continues. The zirconia is essentially unbreakable. The screw is unscrewable. So the last, the last link is actually the bone. So if I tell dentists today, what's going to be happening is that if you're not meticulous with your occlusion, if you're not meticulous with controlling your parafunction, you will start to see more implant failures than you've ever seen before. Because in the past, when parafunction won, the restoration broke. But we have really gotten to the point where these restorations are essentially unbreakable and unscrewable. So now the last part is the bone. And that's what we start to see now.
[25:28 - 25:33] Rob: So essentially at this point the implant and the osseointegration is now the weakest point in the entire restoration.
[25:33 - 26:05] Jonathan: Now, it has now become the weakest point because we've strengthened everything else. And at the end of the day, biology is biology. You know, a lot of my patients, we make sure that we load them up with all the vitamins. We make sure that their bone metabolism is under control with vitamin D, and, every single patient gets full bloodwork before we do any surgery on them to make sure that they are biologically able to receive these screws and more importantly, that these screws stay in their mouth and brings me back to maybe it wasn't so boring to actually have that biology major-
[26:05 - 26:16] Rob: It's funny how things can come full circle like that, right? You thought that you'd moved on to something totally different and here you are. It's back to basic biology again. It's kind of like what we were saying earlier. Man plans and God laughs, right?
[26:16 - 26:42] Jonathan: Yeah. And like I said, you know, we plan in life and we think that we made the good or the bad decision, but everything is pre-planned, it's preordained and everything will come back. You just have to be able to see it. If you're not able to see it, then you just think that everything is haphazard. I think that everything is meant to be. I think we're all where we are, exactly where we're supposed to be. We just have to be able to be able to see it, to be able to understand that this is what we need.
[26:43 - 26:47] Rob: So as I understand, you used to teach at NYU, is that right?
[26:47 - 28:06] Jonathan: So I taught at NYU for many, many years. And I felt that academics was just too politics and ego driven, and it's not really, unfortunately, innovative based. They don't want to do anything innovative. They're not open to new ideas unless they get a grant for it, unless someone's getting paid. So that's when I left NYU, and I started the Smile Syllabus. So that I created sort of my own teaching, environment where it brings masterminds together to be able to create leaders, you know, because really, the people that go through this, the training, they become leaders, whether it was lab technicians, whether it was dentists, whether it was assistants, even. They really became leaders in their field, because their mind was like a parachute, they kept it open. And that's what they were able to do. So I don't teach at NYU anymore. It wasn't an environment for me to be in. They're great. The students are amazing. And I still talk to a lot of my [former] students from there. It's just that academics, unfortunately, is going to need to innovate. It's going to have to innovate in a sense that people are going to stop going to dental school, or even post-graduate programs if they're not able to innovate, really create an environment for students to really learn, really become amazing at what they do.
[28:07 - 28:15] Rob: A moment ago, you mentioned your Smiley Syllabus courses. If you would please elaborate a little bit about what, what your courses are about, what people can expect to learn there?
[28:16 - 28:50] Jonathan: Yes! We want to create leaders. We want to be able to really push the industry to be better. And, you know, people say to me, Jonathan, when's your next course? And truly, the only reason that I give my courses, it's not to sustain my lifestyle. It's really to make an impact in the industry. And whenever I see that the industry is lacking knowledge, whenever I see that the industry is being led in the wrong direction by people teaching them things that are either sponsored, lies, misinformation, that's when I release my next course. So we're getting there.
[28:50 - 28:54] Rob: What have been some of your favorite aspects about teaching your Smiley Syllabus courses?
[28:54 - 32:19] Jonathan: Yeah, I feel like it's- it's a great way to be able to share with people, you know, dentists in general, sometimes they think that what they did was wrong, and their failures are what they do. And, it's okay to be ripped off by a specific company. It's okay to be lied to by your sales rep. It's okay that your assistant spoke to you this way, or it's okay that your patient spoke to you this way, and it makes me sad because I look at every single dentist as my colleague. And, you know, I wrote yesterday in one of my comments, I said, “when you get to the island of IDGAF, that's when you've really reached the pinnacle of, like, calmness”. And I have no problem sharing my failures because it doesn't mean that I failed. It just means that I'm working in an environment where things don't always go perfectly. You know, we're humans. We're not robots. And even robots make mistakes! And you shouldn't be ashamed if an implant fails because there's so many variables that can make an implant fail. You shouldn't be ashamed if a patient said no to your treatment. You shouldn't be ashamed if a patient decided to go elsewhere. Right? You should just be able to say, this is part of life. This is what the business that I chose to be in, how am I going to make the most of it? And I have a very famous saying: Digital dentistry is total epic… Beep! We're just trying to make it less… Beep!-ier. It's just the way it is. Nothing is perfect. Stop looking for that silver bullet. Tell me what to buy. What should I buy? Yes, we know you have money. We know dentists have money and they can spend and buy solutions. But there's no silver bullet. If you constantly look for a silver bullet in life, in dentistry, you will constantly be disappointed. Just look for the one that has the least amount of problems. Understand it has a problem: a computer may not boot up. Microsoft may send you an update and blow your whole day. You know these things happen and that's okay. It's just the environment that we live in and that's what makes our life human. And there's no need to be ashamed of that. So yes, I show failures. If an implant company is doing something that I think is incorrect, and for some reason I always see the mistakes first, I share it. In the past, the sales rep would say, well, you're the only one that has this problem because that's the corporate answer. You're the only one. Of course, that's how recalls don't happen and… And it always starts with one. And that's the power of social media, to be able to unite everybody together, to see the common goal of really helping patients and helping us survive in this crazy environment that we live [in]. I always tell dentists, you know, look at the guy who's trying to teach you. How much is he getting from corporate dentistry? If he's only recommending one product, someone's paying him. If you see his face on that, just one company space, he's getting paid to say this. And at the end of the day, people can be swayed by money. So understand that not everything you hear is true. You have to be able to be able to understand what is and what isn't. Just like when you read a scientific paper. To know that this, does this apply or does that not apply? And that's what makes a doctor a human.
[32:19 - 32:26] Rob: Those are excellent points and absolutely things you should consider anytime you're listening to a lecturer, especially, like you said, if they're just pushing one product.
[32:26 - 32:27] Jonathan: That's right.
[32:27 - 32:39] Rob: One thing I'd love to know. I'd love to know your secret. You're a father. You're a dentist. You're an inventor. You're constantly putting out interesting social media content, and you're teaching your Smiley Syllabus. How do you find the time to balance all of this? How do you squeeze it all in?
[32:39 - 34:29] Jonathan: You make time for things that are important. As simple as that. You know, you have to have time for yourself. You also have to have time for your family, and you have to have time for your profession. You know, you need to invest in what's important to you. And, maybe some things you would just be like, I don't need to waste time with that. You know, people focus on so many things that- I tell my children all the time, don't focus on this. It's not that important in the long run, in the big scheme of things. Just because this person said this or did this to you doesn't even matter. It's just a blip on the screen. Like move on. The more time you give to that, the less power you have. When you allow someone to make you feel inferior. When you allow someone to push you out of your path, then what are you doing? You're letting them win. Why would you let someone else win? You're the one that needs to be deciding. You know, I always say to people, I'm on the bus. I have a destination where I need to get to. There's a lot of seats on my bus. You're more than welcome to jump on the bus with me, but if you want to stand in front of me, I'm going. You're going to get run over. You know? Or. And if you don't want to get run over and you don't want to get on the bus, just get out of the way. Because it's my life. I only get to live it once. And people need to realize that. Don't let other people push you to where they want you to be. You need to be where you want to be in every aspect of your life. So yeah, I find the time because time is there. There's 24 hours. You don't need to sleep that much. You don't need to scroll social media that much. You don't need to work that much. You know, there's a lot of days in a week. And, it's really just about prioritizing what you want and what your mission is for your life.
[34:30 - 34:54] Rob: That's a beautiful way to look at it. And thank you for sharing that. So one other thing I'd like to ask is… What’s something you could share with the dentists who are just starting out, like, one piece of advice, for example, that you wish you had gotten early on in your career. Especially as you were learning and pursuing the more complicated things you got into, like implantology.
[34:55 - 36:05] Jonathan: …Hopefully they don't play this at my funeral, but… I’d really say just to just be true to yourself. Be true to your mission. I will never tell my kids “be happy”. Because I think being happy is almost selfish. Because in order to be happy, someone else has to be unhappy. But I would say every single day, find a way to make the world a better place with you in it. And that’s like giving because people think that they'll receive, they'll have more if they take more from people. The more you give, the more you receive. So if I were to give my kids any advice I would say, understand your mission, understand where you come from, understand who you are, understand your essence. Find a way to make this world a better, better place with you in it every single day. And hope that yesterday will not be as good as today, and tomorrow will be way better than today. And that's what I would say. To be happy is just to be selfish, but to make the place better, to make the world a better place is really the essence of life.
[36:06 - 36:26] Rob: Thank you for sharing that. Those are really powerful insights that I feel like can be taken to heart for really anyone in any industry. And speaking of, what's something that you wish you had learned earlier in your career, especially as you started to get into the more complicated stuff like implantology. What's something you could share with the doctors who were just starting off?
[36:27 - 39:53] Jonathan: You know, I heard a very famous celebrity dentist say something that really impacted me. You know, they say a lot of nonsense, but this was something that was “wow”. He said, find yourself a mentor… Okay? Who cares? That's pretty common. So people said, well, how do I find myself a mentor? And you know, I get DM’s all the time, and people think that “finding a mentor”, and this is his teachings, ok? People think that finding a mentor means asking someone to do something for you. Essentially, hey, can I come watch you? Hey, can you tell me what course to take? Hey can you do this, fill in the blank, for me? That’s not finding a mentor. Finding a mentor is: Hey Jonathan, I see that your Powerball Screw is really amazing, I'm really good at photographing, I’m really good at measuring. I would love to come to your office to help you put together this, and this, and this, and this. How does that sound? When you do something for someone else, they in turn will want to do something for you. You know, someone’s not just gonna let you come into their office. Someone’s not going to just take you under their wing because you asked. That’s not the way things work. You know, because, to have a mentor takes a lot from the mentor itself to give to the mentee. So why would I want to take that on? I have my own four kids to worry about. I’ve got my own patients, I’ve got my own friends. Right? So if you want to find yourself a mentor, and you’ve chosen the guy or the girl you want to be your mentor, see what you can do for them. That’s your opening line. And I think when that guy said that, I was like, “wow!”. And that’s how he got in to become a celebrity dentist. He worked for a celebrity dentist. And he told him, listen, I see that you have all of these things. I want to work in your office. And the guy’s like well, everybody wants to work in my office. Well I’m going to create a club in the college to really blow up your name, to have you come and speak, to really put you out there. Because you’re just in your practice. Nobody knows you other than the celebrities. Right? But I’m going to bring you to this other part. And he said one of his associates called them and said, listen, you guys do gorgeous dentistry, but your pictures suck. I’m amazing, I’m a dental student now. I’m great at taking pictures. I’m going to come to your office twice a week. And I just want- don’t pay me. I just want to take pictures of your cases so that you guys can showcase them. That person now runs their office in another city. You know. You don’t just get it because you ask, and when the person says no, you can’t come to my office, no I’m not teaching you, you need to pay me or take my course, that’s essentially the person saying to you, you didn’t do anything for me. So if you want something from me, you need money. But if you want a real mentor-mentee relationship, money is not really involved. It’s a mutual understanding of what you’re going to do for me, and what I’m going to do for you. So again, if you’re a young dentist and you want to get into this, you need to learn. And just paying for courses is not gonna help you. You need to have some sort of mentor that you believe in their philosophy. And recreate that path in a better and faster way with their guidance.
[39:53 - 40:13] Rob: It's, as you said before, with any good relationship, it should cut both directions. It should be mutual respect. And you can't have mutual respect if you're just asking and not giving. It's, as you said before, it is better to give than to receive. And the more you give, the more you receive. So on that thought and, looking forward to where dentistry is going, what do you see on the horizon? What are some things you're excited about? Where do you see the next, say, 5 or 10 years of dentistry going? What's next for you?
[40:13 - 44:47] Jonathan: And I'll end with this, but… You know, for the past 3-4 years, we saw that implant dentistry had a tremendous amount of… venture capitalist (VC) money invested in it. And this is buying practices, building conglomerative practices, and we see that 3-4 years down the road, that VC has now realized that the full-arch practice doesn’t work without the full-arch dentist. And a lot of these companies, a lot of these practices are completely closing down. And VC is now changing their focus. Their new focus is actually funding litigation. And they are going to malpractice lawyers, and telling them, you know, I know you have all of these patients coming to see you. And I know you don’t really want to take on this case because it’s not worth enough money to you. But we’re going to now finance the case for you. So as a lawyer, before you even go in, we’re going to pay you for everything. Whether you win or not. We’re going to pay for it, and you’re going to go after all of these people. Unfortunately what’s happening in implant dentistry, you speak to any dental student out there, they all want to do implants. They don’t even know what implants are. They don’t understand the stress that’s involved. They don’t understand the dedication to your craft that is needed to be able to be a great implant dentist. So what happens is that people that are 1-2 years out of school, 3 years out of school, are doing these massive surgeries, with zero experience, zero understanding of prosthetics. Zero understanding of complications, hell, I’ve been doing this for 20 years and I’m still learning! Right? And what happens is that the revision game is now the new game. Because the traditional all-on-X arch is just not there. People create all of these fake orientations of FP1, boom, boom, this and that, you know, all of these fake variations of something that’s not even there. And they take out teeth that shouldn’t be taken out, just to create business because the business isn’t there. But the real business is now the revision game. And unfortunately, the revision game is going to be fueled a lot by litigation. And I’m really afraid for that, for people to get really hurt in that sense. And nobody is immune to that. That’s what I’m really scared about. What I’m excited about is that dentistry is becoming more fun. In dentistry, the clinical part of dentistry is becoming more fun than ever! It’s more predictable than ever. When you understand all of the parameters, and all of the things that can go wrong, you make sure it doesn’t go wrong. And it’s actually really, really, really fulfilling! This past Monday we were snowed out. Tuesday, Wednesday, Thursday we did 3 full arches a day! And we don’t deliver the case the next day, we deliver the case within the hour. We design everything ourselves, we print everything ourselves, and we don’t need a massive team to be able to do that. Just because when you understand the flow, it’s actually pretty fun! And being able to understand people and speak to people is really the name of the game. Working with them, and if you’re able to do that, master your craft, really go into it. Not for the money, but for why you think you actually love it. Find the right solutions, don’t look for whatever’s cheap. I always find the dentists that cry that a screw is too expensive, or this is too expensive, you know what? Their patients are the exact same way. My dad always taught me, he said Jonathan, if you’re going to do something, do it the best or don’t do it at all. And that’s the way that I run my life. I’ll always get the best of everything in life, and if I can’t afford it I just won’t do it. And if I can’t be the best at what I do, I just won’t do it. And that’s really the way that I live my life. So I tell dentists, don’t be cheap about a screw that’s an extra $20 in the grand scheme of things. Don’t be cheap about a dental implant. Don’t choose the one that’s cheaper, choose the one that’s the best. You know, kids call it “aura”. When you create this aura around yourself, that’s what you attract. You want to be the guy that goes the get the free gloves, and the free cotton balls, and the free tooth paste at the convention center? Then your patients are gonna come and they’re gonna want to come for the free stuff also. You’re the one that uses every single lab under the sun to get the free 2-crown trial? That’s the kind of patients you’re gonna bring. Level up. Be proud of who you are. Dress like a king every single day. Treat your team like a king every single day. And I promise you your success will follow.
[44:47 - 45:17] Rob: Where can people find you online? Where can people reach out to your socials? Or if they want to look for you, your practice, your Smiley Syllabus. Where can people find you?
[45:18 - 45:29] Jonathan: If you want to, you want to laugh a bit and follow me through Instagram @dr.xcell. If you want to get my screws, my scan bodies, all of my solutions for implant dentistry: thepowerballscrew.com and that’s it. Just smile, live life, and try to make the world a better place, with you in it.
[45:29 - 45:36] Rob: Excellent. Thank you again and thank you for joining us for this episode of the Evolution of Dental Podcast. Please follow us on Apple Podcasts, Spotify, YouTube, and wherever you find your favorite podcast. Like, share, subscribe, share this with your friends. And remember, never stop evolving!
