Full-Arch Implants: Making Treatment More Accessible | Dr. Robert Jung | EODP #34

00:00:00:06 - 00:00:09:10 Speaker 1 There's only so much we can say in half an hour or the hour when you have the initial consult, the message that you know these resins are permanent. 00:00:09:10 - 00:00:17:18 Speaker 1 Was, was and is a little bit misleading. One of my patients said it's the second biggest purchase that he's made in his life after his house. 00:00:17:22 - 00:00:32:21 Speaker 1 Once the implants are in there, in once you've cut that bone, you've cut that bone. There's no regrowing of that bone. 00:00:32:24 - 00:00:54:08 Robert N. 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. My guest today built the something that most Denis only talk about a clinic with an in-house 3D printing lab, a teaching academy all under one roof in London. 00:00:54:09 - 00:00:58:09 Robert N. Doctor Robert Young, welcome to the podcast. How are you? 00:00:58:12 - 00:01:00:20 Robert J. Thank you for having me. It's a pleasure to be here. 00:01:00:27 - 00:01:16:17 Robert N. You and I built something very similar on two continents here, a lab and an education center, kind of all wrapped up in clinical work. What made you decide to build a lab? And what does that change for you in your practice? Like, how did that shift your mindset? 00:01:16:24 - 00:01:51:08 Robert J. I had this idea to try and make full arch implants affordable for dentists and patients, but yet profitable at the same time. So that's kind of what I was trying to achieve. And with the rise of sort of 3D printing and the stronger material of the resins, I thought that through the use of digital workflows and 3D printing, we could sort of help more people and put them on some sort of like a renewal program where every couple of years we can sort of refresh their their 3D printed arches. 00:01:51:11 - 00:02:23:26 Robert J. I got to about sort of, you know, a hundred arches, you know, utilizing that, sort of this, this, this workflow with the strongest resins at the time. And then, yeah, the phones kept ringing where things were breaking and patients, you know, being disgruntled. You know, I talk about this in my courses as well. And yeah, I had this sort of dilemma where do I send these arches, you know, for, you know, to, to an external lab and sort of pick up the bill. 00:02:23:27 - 00:02:55:13 Robert J. I was in a position where I couldn't really ask the patient to sort of pay for it for the upgrade to zirconia. So, you know, I either I was facing with a, you know, this situation where I either sort of spent, you know, 200 or $300,000 in lab fees or do I sort of learn how to sort of do it myself and, you know, asset finance, the, the equipment and sort of, you know, spread a spread over a longer period of time. 00:02:55:19 - 00:03:19:00 Robert J. And that was sort of the safer option for me. And yeah, then that's how the story of the lab came around. So I obviously knew Jonny and Josh Kristen as well. I remember I was leaning on their on their backs a bit, and they sort of advised me to sort of go for the, the VHF machines churning out and milling these, these arches sort of 24 over seven. 00:03:19:01 - 00:03:24:01 Robert N. And what point did you get decide to to start teaching people about this and sharing your experience? 00:03:24:01 - 00:03:51:00 Robert J. The first course that I, that I ran, it was actually a 3D printing program. So I joined the central 3D printing group set up by Rick Ferguson. And this is actually how I met the guys that evolve, where I think on the printing group, I was sort of trying to see how we can use these hobby 3D printers or as you guys call it, gumballs, gumball printers, how we can sort of utilize them and maximize their potential to help. 00:03:51:01 - 00:04:12:14 Robert J. Again, at the time, I if we remember why I started this, it was to basically make fallax as affordable as possible to both dentist and patient. Through the comments, I think I spent literally the best part of a whole month just reading the posts and all of the comments at the same time, and that's when I saw Josh Josh's name pop up. 00:04:12:14 - 00:04:39:18 Robert J. Joshua Jackson, and I just kept seeing this. I thought, this guy really knows what he's talking about. So I reached out to him and then it turns out we have a very we have a Polish connection. So his family's Polish, my family's Polish. So we we had something in common there. And then he proposed, you know, for us to sort of travel to, to the facility in Buffalo at the time, you know, I had a mentor of mine, Adeel Ali. 00:04:39:19 - 00:05:00:26 Robert J. We traveled together to, to Buffalo, and it was only supposed to be a small group. And I think in the end, 12 of us sort of ended up coming. Yeah, we went to the we visited the facility. We saw, you know, the lab set up, you know, all the printers you guys were using or the desktop scanners and the eye cams and everything. 00:05:00:27 - 00:05:24:07 Robert J. Yeah. We had I think it was a two day program. And, you know, I remember that time. And I cherish those memories because, yeah, we you guys treat us like family. And yeah, we had a we had a really good time. So you know Andy and and everyone there as well. All of them, they really they were great hosts and really made us feel welcome. 00:05:24:12 - 00:05:36:26 Robert J. We learned a lot about sort of, you know, digital for large. And yeah, then that was the first sort of step into to what we're kind of doing pretty much today. 00:05:36:29 - 00:05:42:13 Robert N. What's something you saw there that like really struck you like something you didn't expect to see maybe. 00:05:42:15 - 00:06:10:12 Robert J. I mean, I was so excited about actually seeing the whole, you know, production of, of these arches in a digital way. And I was really sort of into, you know, how do they. How did they design these arches, the data acquisition, the manufacturing. So I remember Johnny was showing us sort of how to how to how to print the teeth, how to post process. 00:06:10:12 - 00:06:24:18 Robert J. And I think on one of our friends, we actually printed and delivered an implant crown that he had and had restored it in over ten years, so that that whole experience was really, really cool. So yeah. 00:06:24:20 - 00:06:28:18 Robert N. One of your friends, actually, you did a restoration there on the spot. 00:06:28:19 - 00:06:30:03 Robert J. Yeah. So he had. 00:06:30:06 - 00:06:31:15 Robert N. I hadn't heard that part. 00:06:31:18 - 00:07:02:26 Robert J. Yeah. So he actually had two implants done many years ago and he never had them restored. And yeah, we took a scan with the medic that was there at the time. We had a sort of a stock abutment and delivered a 3D printed implant crown there and then. So yeah, it was, it was, it was, it was cool to see the whole process, the design, the the printing, the post-processing and then the final fit. 00:07:02:26 - 00:07:38:01 Robert J. So yeah, that's something that, you know, when you see in reality that was such a cool thing. And then I thought, okay, there's not much being talked about in the UK about this. And I wanted again to sort of spread the message and help other dentists get in on this. So I think about two years ago in March, I delivered my first program, and I think about 15 or 16 people sort of came and I showed them sort of how to make these arches and how to print them, the designing and everything, the whole post-processing. 00:07:38:03 - 00:08:02:03 Robert J. So that was it was a one day program. And I think we repeated it again a couple of months later. So yeah, now we're sort of teaching different workflows. Now I'm sort of trying to teach dentists sort of about the digital workflows, not just one way of doing things, but what works in my hands and what I find that's really predictable and and super efficient. 00:08:02:03 - 00:08:03:25 Robert J. Basically. 00:08:03:27 - 00:08:07:05 Robert N. That's fascinating. 00:08:07:07 - 00:08:24:26 Robert N. Oh, I didn't see you there. Hey, y'all, it's Robert with the Evolution of Dental podcast. If you love these stories and you want to see more guests, more content and help the show, please remember to share it. Like it? Subscribe to our channel and hit that little notification bell if you're watching on YouTube so you can get notified of our new episodes. 00:08:24:27 - 00:08:32:24 Robert N. New episodes drop every Friday. Follow us on all the socials. You'll see all the latest content. Looking forward to seeing you there. 00:08:32:26 - 00:08:55:06 Robert J. I think I remember in that first program I had, there was some dentists that were willing to embrace the digital workflows, and there were others who were really sort of stuck. You know, they were, I wouldn't say stuck, but they've just been doing something that works for them for for so many years. And then some of them have adopted this, this new way of working. 00:08:55:07 - 00:09:23:15 Robert J. Others have chosen to sort of stick within their comfort zone. But now, nowadays, I think the access to sort of all the information, especially with social media, we're all seeing sort of these 3D printing workflows being implemented. I wouldn't go back to sort of doing traditional ways of doing things. Everything is just fully digital. If I can, if I can call it that. 00:09:23:18 - 00:09:44:24 Robert J. There are some issues with interest scanning if you're just purely reliant on that, that I found. And yeah, all of these sort of reflections, I sort of try and bring them to light and tell people, look, guys, if you do things this way, these are the issues that you're going to come across. Trust me, I've been I've done it. 00:09:44:24 - 00:10:06:05 Robert J. And yeah, this is the proper way of, of of sort of doing it so that you don't have to, you know, see these patients for multiple times and you don't have to see these patients for remakes or, you know, forever retitling the bridges. So yeah, all of these things, they, they come out in the laundry as we, as we say through trial and error. 00:10:06:05 - 00:10:07:19 Robert J. So yeah. 00:10:07:21 - 00:10:15:08 Robert N. What do you feel like is over promised. And what do you feel like is really where 3D printing is shining, either in the lab or in the practice. 00:10:15:09 - 00:10:50:17 Robert J. So again, through my own experience, I felt like the message that, you know, these resins are permanent was, was and is a little bit misleading. I don't think that we're quite there yet in terms of permanent. But again, what is the definition of of permanent. You know, what are we comparing it to? I mean, I know for a fact you can't compare as a crown with a 3D printed crown with even the highest filled zirconia content. 00:10:50:19 - 00:11:22:05 Robert J. You can't compare. So at the end of the day, it's it's sort of there's so many factors that play a role, especially when the clinician is there with the patient. We've got so many things to take into account. I've been in enough of those situations to the point where I've actually written a book about for large for for patients, and I'm in the process now of actually making a video format of it so that they're fully informed of what they're really signing up for. 00:11:22:07 - 00:11:23:09 Robert N. You wrote a book? 00:11:23:17 - 00:11:24:12 Robert J. Yeah. Yeah. 00:11:24:13 - 00:11:28:07 Robert N. That's that's pretty cool. Can I get it on Amazon? What's it called? 00:11:28:08 - 00:11:35:14 Robert J. Well, it doesn't have a title yet. I'm still thinking of that, but it's basically a full arch title. 00:11:35:21 - 00:11:37:03 Robert N. Large? 00:11:37:06 - 00:11:59:23 Robert J. Yeah. For large, for large booklet for for patients. No, it's more of a, like a consent where there's only so much we can say in half an hour or the hour when you have the initial consult. And there are so many scenarios that happen to us. Screw loosening, you know, one of the silicone plugs comes out or whatever. 00:11:59:24 - 00:12:28:12 Robert J. And, yeah, some patients get irritated by that. And I just wanted I just I was just tired of constantly having to, you know, live in this reactive mode. Okay. Patient calls up. This has happened. You know, they're booked. It's an emergency when it's not really emergency. So I just said to myself one day that, look, I have to write a book chapter by chapter, you know, about the reason why they got into this situation in the first place. 00:12:28:13 - 00:12:50:08 Robert J. You know, giving them the message and communicating in a very clear way that this requires lifelong maintenance as well. It's not a case where you have it done, and then you disappear for sort of 5 to 10 years. So yeah, I was just it just got to the point where I was like, you know, I'm going to write this book. 00:12:50:11 - 00:13:22:25 Robert J. I'm going to make it in video format as well, so that there's no excuse that, you know, they couldn't read it or something, something interactive as well. So they're really educated. So, yeah, I'm still finishing it off, finishing off the final details. I've also opened it up to my dental community here in the UK, where any sort of experiences or strange situations that they've come across that they can sort of chip in and add to it and then, yeah, we just make it sort of available to download. 00:13:22:26 - 00:13:29:11 Robert J. There's no sort of it's not not for profit. It's just to share sort of the reality of, of of what we do. 00:13:29:13 - 00:13:48:20 Robert N. That's, that's really, really cool. And it kind of reminds me of it reminds me we did episode a couple, a few weeks back with Doctor Russell Schafer, and he was talking about how you have to you have to talk to the patient and say, like, look, this is not enough. Like you said, nothing is permanent. This is a prosthetic. 00:13:48:23 - 00:14:06:15 Robert N. You have to kind of learn to live with it. And it's not the teeth that you were given by God. These are the teeth that we created to work as a prosthetic, in the same way that if you lost your leg in a car accident, you wouldn't expect to go out and run a triathlon with the new with the new prosthetic, you can't expect that from your new teeth either. 00:14:06:15 - 00:14:24:28 Robert N. And one of the things you mentioned there, though, is your community that you've built up. You've built a really big community around your classes. What's that? What's that look like for you? How's that? What did it feel like when that started to explode? And and then where where where does it put you today? How does that influence your clinical work? 00:14:25:00 - 00:14:51:14 Robert J. I, you know, I don't think it's influenced my clinical work that much, per se, but, I think, yeah, just being able to have that community where we can share, share our experiences, share our failures as well. I've always been the kind of person where I'm not afraid to sort of share what I've done, what I've done wrong, or what's happened to me. 00:14:51:17 - 00:15:15:15 Robert J. I don't think there's there's enough of that to go around. Because we don't really learn from sort of all the slam dunk cases. We learn from the ones where, you know, things don't quite go to plan, and then you reflect on that and then you tweak a few things and ultimately, yeah, things that I was doing things in one way 5 or 6 years ago. 00:15:15:15 - 00:15:36:19 Robert J. And nowadays, you know, like I said earlier, you have to learn the hard way sometimes. And now I have dentists, sort of, you know, that I mentor now and they come to me for advice. They say, look, what should I do? And then I'm able to sort of give them that shortcut in a way of, of, of they don't have to go through the pain that I felt. 00:15:36:19 - 00:16:04:26 Robert J. They'll go through other painful moments. Of course, everyone has to but yeah, they can just sort of right off the bat, learn, learn, learn how to do things the way which will give them the least stressful sort of the less the least amount of stress. And I was just what you said. He's I was just listening to what you said a couple of moments ago. 00:16:04:27 - 00:16:18:03 Robert J. I say to my patients that, look, God didn't give us a guarantee on our own teeth, and I'm not God. So that's that's what I tell my patients all the time. How long will this last? I saw a God, you know, didn't give you a guarantee on this. So. 00:16:18:06 - 00:16:20:07 Robert N. Yeah, depends on how you take care of it, right? 00:16:20:08 - 00:16:22:08 Robert J. Yes. That's it. 00:16:22:11 - 00:16:43:24 Robert N. I do really like what you were talking about a minute ago. The humility of sharing the failures, these old saying that my grandma used to say, actually, it was like you showed me a man who's never lost. I'll show you a man who learned nothing throughout his life. But one thing he said a moment ago that also really hit me was you said things that you were doing 5 or 6 years ago that you do differently. 00:16:43:24 - 00:16:47:20 Robert N. Now, what's an example of something like that? 00:16:47:23 - 00:17:27:08 Robert J. So, yeah, 5 or 6 years ago when I, when I started, I'm talking about full ups now because that's pretty much all I, all I do now. And of course, the journey to get to this point, it's a 5 or 6 year journey in my case where that's pretty much exclusively what I do. But yeah, five, six years ago, after seeing seeing you know, what what what Josh and Johnny are teaching, then I, I purchased the easy ref system and yeah, I was, I was doing sort of all of those scans, you know, with the fiducial markers and and it worked. 00:17:27:09 - 00:18:04:09 Robert J. It worked. Well, of course, you know, there was a bit of a, some bite adjustments. So with double arches it wasn't, you know, slam dunk. So all the time, but and now we're sort of doing CBT alignment for, for double arches, which is something that, you know, a couple years ago, you know, I wasn't, I wasn't doing and now it's we're doing the CBD arches and a lot of patients that works well in other ones where they've had a lot of missing teeth or their indentures and, you know, their jaws have been protruded for a long time. 00:18:04:12 - 00:18:32:08 Robert J. You know, that initial, data capture on that consultation, it's, you know, when you then finally fit the temporary teeth on the computer, everything looks like it's in class on. But recently, I just had a situation where I had a massive class two because the dentures were actually made in a in a protruded position. So it's these things that sometimes catch you out, but thankfully we're able to sort of, you know, send the patient home with teeth. 00:18:32:09 - 00:18:47:17 Robert J. It's better than what they came in with. And we're able within a day or two, we can fix it up and bring the teeth a bit more forward. So yeah, all these little things, that's that's how everything sort of evolved now. So yeah. 00:18:47:19 - 00:18:52:25 Robert N. And one thing I want to ask you about before I forget, can you tell me a little about that jersey you're wearing? 00:18:52:26 - 00:19:16:02 Robert J. This is the of visa, which is one of the two teams in the place where I studied in Poland. So I actually studied at dentistry in the Medical University of God. That was ten years ago. I graduated ten years. I never went to a football game during my college years. But then just a couple of months ago, they were in the relegation. 00:19:16:02 - 00:19:31:23 Robert J. They were thinking, you know, 16th in 16th position. So my friend who's a season ticket holder, I said to him, look, we we have to go to this game. And it was the last game of the season and they had to win the game. So I got this jersey a few months ago. I've got my name on the back. 00:19:31:24 - 00:19:33:01 Robert J. Personally. 00:19:33:03 - 00:19:49:07 Robert N. That's a lot of fun. So one of the things that I found, at least in my life, that's able to kind of free up some more of my time is I've been using a lot of more AI tools lately, both in dentistry and also to kind of just manage my workflows. How about yourself? Where do you see AI fitting in the dentistry? 00:19:49:07 - 00:19:53:00 Robert N. Are you using any of these tools and how are you using if you are? 00:19:53:02 - 00:20:21:00 Robert J. Yeah. So I'm not sort of the biggest AI guru. I'm sure there's there's loads of tools that I'm I'm not I'm massively under utilizing the potential of AI. But yeah, I've got a chat, GPT account, a little bit of Claude and yeah, sometimes if I need to sort of make a decision on something or then you put it in a spreadsheet, put it in a visual format, you know, content creation, that kind of stuff, those sort of ideas. 00:20:21:00 - 00:20:34:13 Robert J. So that's what I mainly use it for. And yeah, it seems to me a lot of time. On the one hand, it saves me a lot of time. On the other hand, I can get through these ideas a lot faster. So I ended up doing more than I really should. So, 00:20:34:15 - 00:20:42:20 Robert N. Yeah, I've seen that to where sometimes the idea you have grows into from, like, a. Oh, this would be a cool idea to like, oh, this is now a thing. Now it's a project. 00:20:42:21 - 00:21:15:23 Robert J. Yeah. So, so now with the lab, we've kind of what, what we've done is I've sort of branched out sort of two, two websites which I built with, with AI. So we have, yeah, a website where clinicians can send through if they need a surgical guide, they just go and design my or mail and yeah, if they need something done, then we can sort of look after them and design those guides or manufacture the their final bridges. 00:21:15:23 - 00:21:38:03 Robert J. So that's another way I've sort of implemented the AI. Yeah. I mean technology definitely helps us become more accurate. There are moments where you have to pivot. And I say to to the guys that I mentor, if you're doing, for example, this is in a guided way and you can't do it in a 300 way, that's a dangerous place to be. 00:21:38:03 - 00:22:07:09 Robert J. Because what if the guide doesn't fit? What if the bone isn't as it is? You know, who are you going to call? You know, if you're there by yourself, you know, enabling, thinking that everything's going to be great. So, yeah, I think developing that, that feel and that freehand skill is important. And then of course, use the technology, use the guides to to help you become more efficient and cover yourself and and yeah. 00:22:07:12 - 00:22:10:00 Robert N. Kind of a trust but verify situation. 00:22:10:02 - 00:22:44:29 Robert J. For sure. For sure. I mean you have to. Yeah I mean you can feel things. You can feel you can feel the bone. You can feel the talk through guide. Sometimes you you don't you can't feel it. But yeah, like I said before, it's good to sort of master it the sometimes the old school way because having that in your, in your tool in your toolbox can get you out of some, some situations that all of us find ourselves in. 00:22:45:01 - 00:23:17:07 Robert N. That, that kind of keys up a couple of things in my brain. One was excellent insights. Tilman Steinberger, you know well the founders of Exo CAD, he was talking about how they intentionally limited what Exochus AI can do to force the technician to still be involved in the design process, because they feel strongly that that human oversight is a huge component in making a having a successful restoration, having a successful experience of the patient. 00:23:17:08 - 00:23:25:25 Robert N. What is your digital workflow look like and where do you see this going in about ten years? If you could put on your like forecasting hat, if you will. 00:23:25:27 - 00:23:39:11 Robert J. I really admire what he said and what he's done. And completely agree. Are you asking me about my digital workflow in in large or. 00:23:39:13 - 00:23:49:17 Robert N. Yeah, your digital workflow within full arch. Like, just like an overview. Like what does it look like for for the people who are interested in your classes? 00:23:49:19 - 00:24:25:07 Robert J. So yeah, a good good it all starts with the consultation, finding out what the patient wants and what their needs are. And then obviously data acquisition is very important, capturing the data accurately, capturing the bite. Is the patient in CRPS or not. How do we get them. Try try and get them into that position. Sometimes we can't. So if we know that from the outset, then we know that we're giving ourselves up to multiple trains to sort of dial in the bite. 00:24:25:09 - 00:24:48:08 Robert J. But yeah, we are quite we take this seat, we take our internal scans, we take good clinical photos. We send that off to the to the lab. The lab does the planning. So again delegation is important. Delegating to a team that knows what they're doing and then having that oversight. So I personally don't go and position the implants because I just don't have the time for it. 00:24:48:08 - 00:25:05:12 Robert J. But I leave that to to the lab. And I know I trust that what they're doing, we do sort of 2 or 3 arches a day. So, you know, they know exactly what I need. And then they send me the plan for approval. I have a look, I can see, okay, this is good. AP spread implants in good bone. 00:25:05:12 - 00:25:28:25 Robert J. This is how we can do it. And then when, when we come to, to to the day of the surgery then. Yeah. At the moment I'm sort of using a guide. Guides used to slow me down, but now I'm sort of pretty pretty much there compared to sort of freehand. And it also makes the surgery go super smooth. 00:25:28:27 - 00:26:03:14 Robert J. Sometimes I would sort of second guess, am I in the right position? But yeah, with with this guide, I know that if it's sat properly then, you know, I know, I know, we're good. My assistants calm. I'm calm. The patient's calm, everything goes super smooth. And then, yeah, we use different workflows depending on the situation. So, if we're doing a single arch, we will use sort of the horizontal sort of scan body method with easy rev, which, you know, speeds up the conversion time on the on the day of the surgery. 00:26:03:14 - 00:26:27:20 Robert J. If we're doing double arch then we will use a workflow. And yeah. So that's, that's how we, how we do it that all of that information then gets sent to the designer. They do the the 3D design and the conversion. They send the email back, we print it and then yeah, once once we sort of, you know, post-process that we fit it. 00:26:27:20 - 00:26:48:13 Robert J. Patient goes away, they come back a week later, we just make sure everything's okay. And then when they come, come back. Then we take our we take an I can just to sort of verify and triple check everything that then gets sent to the designer. They tweak any sort of changes. You know sometimes multi units get loosened up. 00:26:48:14 - 00:27:11:26 Robert J. We're tighten them and yeah then we deliver the final. Final bridges. So yeah that's pretty much the workflow. And now I'm in the stage now where I'm trying to sort of think of a way how we can implement your tracking. So then we can actually replicate the patient's sort of chewing function and pre-operative and move it to post-operative. 00:27:11:29 - 00:27:19:17 Robert N. It's interesting to me that you that you incorporate the iCam later in the process, as opposed to like right after the day of surgery or something like that. 00:27:19:18 - 00:27:28:15 Robert J. So it depends. It depends on the workflow. I found that with something, for example, when you're using. 00:27:28:18 - 00:27:50:01 Robert J. You know, we are pretty much like 99% there, you know, with, with the acquisition. I mean, for sure, it helps with scanning the lower arch. You know, it doesn't matter what scanning you have. Scanning the lower arch is hard. You know, if you don't have, you know, these long sort of scan bodies and if they're not orientated in the correct position. 00:27:50:03 - 00:28:11:21 Robert J. So that's where it definitely helps. And also from a design standpoint, the actual alignment with, with iCam on the day, a lot of my patients bear in mind, in the UK, I would say 80% of my patients, they're not sedated. I think in America everyone is pretty much sedated for a procedure like this. Or most. 00:28:11:23 - 00:28:13:13 Robert N. Most of your patients aren't sedated. 00:28:13:14 - 00:28:15:03 Robert J. Or not sedated. No, no. 00:28:15:07 - 00:28:16:25 Robert N. Very interesting. 00:28:16:27 - 00:28:40:26 Robert J. That's why time is of the essence. You have to num num the patient up efficiently. You have to raise the flap, remove the teeth. I tend to have, like, a ten minute rule where the numbing up ten minutes, tooth removal ten minutes, and then I'm talking about all of the teeth, not one tooth. And then once the implants are in, then one quick scan with the easy ref and you send that off to the designer. 00:28:40:27 - 00:29:03:21 Robert J. That conversion process is very quick. So typically the patient will will leave with teeth within sort of two hours. If we add an extra step with the I can, then that's where I've noticed on the day of the surgery. Sometimes that slows us down. That that cancels us down. And I've got to bear in mind that the anesthetic is, is is wearing off. 00:29:03:24 - 00:29:07:07 Robert J. I don't have the the luxury. 00:29:07:14 - 00:29:10:07 Robert N. Is way faster to just drop those in and scan that. 00:29:10:09 - 00:29:31:15 Robert J. Exactly. So, you know, if I know that I'm going to retire in a couple of months time anyway, then I can factor in that time where they're not well, they're not sedated either way, but I can. The day of the surgery is crucial for me, so I want to keep it as short as possible, deliver those teeth as quick as possible and for them to leave the surgery. 00:29:31:15 - 00:29:43:17 Robert J. And it's mainly for their benefit, so that, you know, they can go through that experience and just and go home and start recuperating. So, so yeah. 00:29:43:19 - 00:29:50:14 Robert N. What's why why no sedation? 00:29:50:17 - 00:30:09:05 Robert J. I think it's I mean, if someone asks for I mean, we give the option, of course, but patients sort of ask, you know, you know, do I really need it? You know, how long will it take? I mean, if they know it's going to take a whole day, then then then most of them go for that option. 00:30:09:05 - 00:30:31:11 Robert J. But, I don't know if I when I tell them, look, you'll be sort of two, 2.5 hours, then they say, okay, yeah it's fine. You know, it's it's no cost is also an issue as well. Patients try to see how they can reduce the cost. I mean, where I work we we again the philosophy is to try and make it affordable and as accessible as possible. 00:30:31:11 - 00:30:55:14 Robert J. We actually had a patient from the US from Colorado come in flight. He flew in all the way from Colorado to have treatments. And yeah, we were able to sort of sort him out within a week. So, yeah, that was a really cool. That was the first sort of the furthest sort of patient that's flown in. And we were able to to treat him then. 00:30:55:19 - 00:31:02:03 Robert N. All the way from almost the other side of the world. Like, where would they find you online. How did that work. 00:31:02:07 - 00:31:25:26 Robert J. So they, they, they were doing their research on YouTube. And I think one of the adverts of, of the practice sort of popped up on YouTube somehow the algorithm just picked out London, UK, and yeah, then they liked what they saw, they clicked on it and then they inquired and they flew in, and yeah, they were there. 00:31:25:29 - 00:32:03:05 Robert J. They were thus for about 20 days and we were able to perform the surgery, deliver the temporaries and then fit the finals a week later. So we in the UK, we're using this. Well, I'm using this implant system called incerta. So what are my good friends. He's actually developed the incerta implant system where the multi-unit or as they call it the profile is very slim. 00:32:03:07 - 00:32:28:19 Robert J. So that helps the curtain as tissue sort of grow, grow there. And the way you insert the profile, you, you talk it in together with the implant. So it's not like a traditional multi where there's like a hex you talk it in. So you're talking this component angle correcting component together with the implants sometimes at 4050 mutants and there's zero loosening. 00:32:28:21 - 00:32:56:11 Robert J. So that helped. It helps on many different levels. And it's it's like the perfect guided system. So we already know on the guide where to position these these components. And thanks to this sort of new new component and the way we're delivering it, we're able to sort of in this case, we're able to finish within a week. And that was with an FP1 prosthesis as well. 00:32:56:13 - 00:33:14:18 Robert N. That's impressive. That's impressive. And hey man travel across the world. See London beautiful city. Like if you if you go ahead and get yourself beautiful new teeth properly restored and also you know spend spend basically a month walking around London like it's doesn't sound so bad actually. 00:33:14:20 - 00:33:35:00 Robert J. Yeah. No he he yeah it was it was a good it was a good experience for us and and we made it as good of an experience for him as well. He was an amazing patient and he gave us a really nice gift as well of these handmade drawings at the end of, of the skull. So it was a very nice gesture. 00:33:35:00 - 00:33:47:27 Robert J. And, yeah, we keep in touch. We keep in touch because, yeah, it's not every day you get to sort of treat someone from, from so far away. So yeah, we check in on them and make sure everything's okay. 00:33:48:00 - 00:34:02:21 Robert N. That's fantastic man. What's what's something if some when patients this gentleman or otherwise walk in to your practice. What's something that you hope that they see or take away that has nothing to do with the technology you're using? 00:34:02:24 - 00:34:29:19 Robert J. I think it's just the care and compassion that we sort of show. I mean, we don't really do it for the money. It's more of that feeling that you get when you actually take someone from A to B. That's the most rewarding feeling. And that's why that's why I love doing it. And that's why I fought so hard, you know, to to try and make it accessible and to try and help as many people as possible. 00:34:29:21 - 00:34:36:25 Robert J. So we've made it sort of possible for them financially without compromising on, on, on quality. 00:34:36:26 - 00:34:59:06 Robert N. So many of the things that you've talked about are, are really just opening up access to patients that might not otherwise be able to get there financially. Like, it seems like everything from building the lab and house to your choices in 3D printers, the lack of sedation. Rather, that's it's just all building into making this more accessible. That's that's super inspiring. 00:34:59:06 - 00:35:16:07 Robert N. You said a minute ago that one of the elements of this was standardization for your for your processes. What's something that you've standardized that will really changed how how you approach these things or what's something you standardize that really shifts the mindset of some of the clinicians you teach. 00:35:16:09 - 00:35:55:19 Robert J. I think for me, the one thing is putting the ego aside, because I know, I know there are there's different camps of of implants. Just, you know, we have the free hand guys. I was a free hand clinician myself. And then and now I've sort of transitioned to, to guided not because I can't do it, but because it just gives me that extra sense of comfort, peace of mind, zero stress, you know, and I know, you know, if you if you've done things free hand so many times, then then of course, you're competent and you're confident, you don't feel the stress. 00:35:55:19 - 00:36:21:21 Robert J. But I think, you know, having doing things in a guided way where you're doing the planning, you're having another pair of eyes look at the case. You know, sometimes the technician will say, look, Rob, you've asked us for an FP1 here, but we've actually looked at it and we we think NFP is better here. And then there's this sort of a little bit of yeah, back and forth, this this dialog between us. 00:36:21:21 - 00:36:44:03 Robert J. And ultimately we decide on what's best, what's the best outcome. And we don't sort of paint everyone with one brush and everyone gets in FP3. We strive to try and try and sort of make things as natural as possible. The design, this is where the design is probably the most important thing and the design is very important. 00:36:44:03 - 00:37:01:18 Robert J. And you need that human knowledge and that human touch to basically manipulate the teeth in a certain way, to manipulate the healing as well. I know some aspects of that, and there's some softwares out there that can, can, can do that. But. 00:37:01:20 - 00:37:19:12 Robert J. Those softwares, either you as the clinician have to sort of be there and tell it what to do, which most of the time we don't have that time because we're just focused on the surgery. And yeah, you want someone who's actually done it, you know, thousands of times does, you know, four, five, six, seven designs, conversions a day. 00:37:19:12 - 00:37:35:02 Robert J. And they know exactly what to do. So, yeah, designers don't have to worry, I would say anytime soon, but, but. Yeah, yeah, that's what I, that's that's what I would say. 00:37:35:05 - 00:37:49:01 Robert N. That's so interesting because I asked you about work standardization, and the first thing you landed on was, was basically humility. 00:37:49:03 - 00:37:57:23 Robert N. It seems like it sits above that like it's more holds more gravity, so to speak, than than any kind of workflow. 00:37:57:25 - 00:38:03:00 Robert J. Yeah. I think, yeah. I mean. 00:38:03:02 - 00:38:34:24 Robert J. If I was, if I was a patient, and I think it's very easy to, it's very easy to, to miss this because sometimes we as clinicians, we get so caught up in the numbers or, you know, the surgeries, the amount of surgeries. But when you sort of really sit down and think, man, I'm having this huge procedure done and it's one of my patients said it's the second biggest purchase that he's made in his life after his house. 00:38:34:26 - 00:39:09:11 Robert J. And that's the reality that we sometimes have to think, take that into account. And it means a lot and you don't really get it's not like a feeling that you can sort of redo once the implants are in there, in once you've cut that bone, you've cut that bone. There's no regrowing of that bone. Once you've if you take a 30 year old and once you've removed that bone and given them an FP3, when really they could have had an FP1 then. 00:39:09:13 - 00:39:35:19 Robert J. I think in those situations you sort of done a massive disservice to the patient and in this sort of line of work, it's all about relationships, it's all about building the trust. The patients are really putting a lot of trust more than we even realize a lot of the time in you as the person to look after them with their teeth almost for the rest of their life. 00:39:35:21 - 00:40:07:07 Robert J. So yeah, it's, I would want, if I was a patient that I would like to know, and I would like to know the fact that the dentist has a team that he consults with. It's not just, you know, him. There's other people looking at the case, having their input on the case, designing a minimally invasive sort of plan, but at the same time, you know, giving it sort of the best long term outcome as well. 00:40:07:09 - 00:40:30:26 Robert J. I would want as a patient if I was going through like this, knowing that my, my surgeon has sort of done all of those things, rather than sort of treating people as like a conveyor belt, which we see sometimes when they go abroad, you know, to some of these countries where the reality is that people are treated like just it's like a factory and it's a conveyor belt patient in patient. 00:40:30:27 - 00:41:00:19 Robert J. Now, most recently I had a patient, she traveled to Albania to have two, two implants done. She didn't speak any English and she was Spanish. So I was a bit confused as to why. What Albania. What was very sad was that she was sedated and they ended up removing all of her teeth, and they gave her an all on six on the top, all on six on the, on the, all on four on the bottom. 00:41:00:23 - 00:41:23:08 Robert J. And what's worse, in my opinion, is the way they restored the teeth they screwed on this metal bar onto the multi units. What they did was they, they screwed in the metal bar onto the multi units and the zirconia teeth. They glued it on top and there were no screw axes holes. So there was no way to retrieve it. 00:41:23:08 - 00:41:24:20 Robert N. And no. 00:41:24:23 - 00:41:48:14 Robert J. Everything was just moving around. But there was no way of unscrewing it. So you can imagine, you know, when I took over this case, the amount of drilling, the buzz and the time it took me to take all of that off and try and fix her up, in the end, we managed to get her into a position where she had a metal bar with a Connie on the top and a PMMa, like a hybrid with a metal bar on the bottom. 00:41:48:14 - 00:42:13:20 Robert J. And that's sort of that stabilized her. But yeah, these, these unfortunate situations, they happen. And this is exactly why I, I want to get the message out there to the patients that, look, this is this is not a product that you just get off the shelf. You know, this is a custom made device that's bespoke to you, and it's your maintenance is the most important thing. 00:42:13:24 - 00:42:25:03 Robert J. It's going to be probably one of the most important things that you have to take care of in your life forever, basically. So that's the that's the reality. 00:42:25:06 - 00:42:34:11 Robert N. What a journey, man. I can't imagine how much grinding there had a getting that zirconia off of off of the ball with no access. Oh my god. 00:42:34:13 - 00:42:41:21 Robert J. Yeah yeah, yeah, I lost a lot of hair. I don't have a hair transplant after, so. 00:42:41:24 - 00:42:48:19 Robert N. I mean, it's at least there's a happy ending. Like, ultimately you did find. You did find a solution that works for her. 00:42:48:21 - 00:43:06:26 Robert J. Yes. Yeah. Yeah, yeah. So you know, thankfully, thankfully, it's all she's she's all stable and good now. So. Yeah. So yeah that was a one of those painful moments. Yeah. Happened not too long ago. About six months ago. 00:43:06:29 - 00:43:18:08 Robert N. Speaking of starting things like that over, if you, God forbid, had to start completely over tomorrow. What what what technology would you be out there shopping for? 00:43:18:11 - 00:43:42:17 Robert J. That's a good question because I'm I love technology, I love tech, so I want everything. I want everything yesterday. I'm very impatient when it comes to these things. And I've got it always got to be the first to try. And as you know, I've, I've sometimes you pay the price for being the first. But, you know, my first scanner, the. 00:43:42:19 - 00:44:04:21 Robert J. I 600 for myself. I've said this in some of my previous presentations that if I could go back, the intro scanner was a good purchase. The printer was a good purchase. I would have probably, if had it not been for those issues. With the breaking of the 3D printed bridges that I come would have been the third purchase. 00:44:04:21 - 00:44:27:07 Robert J. Rather than opening the lab, if I had the choice not to open the lab, I would have probably just kept it simple and do it that way. Just quite. Design is probably the one of the most important elements good implant placement, planning and design that's the most important. Then the rest. If you pass that over then yeah, it's then that's a that's a good combo. 00:44:27:09 - 00:44:34:27 Robert J. Because then all of these bottlenecks sort of that you've just introduced into your into your life. So yeah. 00:44:35:00 - 00:44:38:27 Robert N. It's important to have that good teamwork relationship with your technicians. 00:44:39:00 - 00:44:39:26 Robert J. For sure, for sure. 00:44:39:29 - 00:44:42:17 Robert N. And have that open line of communication. 00:44:42:19 - 00:44:45:25 Robert J. That makes that makes all the difference. 00:44:45:28 - 00:45:05:07 Robert N. And speaking of this technology, and I mean, I'm a big nerd myself or anybody who watches his nose on a huge nerd. And I love tech. Where do you see this going in like ten years? What do you I mean, I know you mentioned earlier, you're really looking forward to some kind of either physical or AI jaw movement, jaw motion technology. 00:45:05:08 - 00:45:13:09 Robert N. What else do you ever see coming or what do you hope to see show up down the pipeline? 00:45:13:12 - 00:45:16:27 Robert J. I think there will be. 00:45:17:00 - 00:45:41:20 Robert J. I think there will be some advancements in automating design. I know there's some softwares out there that, automate the design process where it's literally like click and drag, drag and drop, you know, your files, and then the AI will sort of do it. But again, it requires still you to learn the software and, and manipulate that design. 00:45:41:23 - 00:46:00:05 Robert J. So I know that there will be for sure some advancements on that. And it would be cool to try and get the printed materials to be as strong as, as as sort of, you know, what we have available today because. 00:46:00:05 - 00:46:01:02 Robert N. The Holy Grail. 00:46:01:03 - 00:46:32:08 Robert J. Yeah, that that is I mean, I know, I know, there are some companies working on resins where you printing zirconia. I know there are there are printers out there that can print zirconia. But yeah, just just printing this in a way where it's accessible to, to us and also, yeah, shortening the post-processing time in a way that doesn't compromise the end result. 00:46:32:11 - 00:46:41:05 Robert J. I quite like what we're doing now to be honest with what we have now. I mean, how much faster can you go? I mean, I wish. 00:46:41:07 - 00:46:42:02 Robert N. I mean. 00:46:42:05 - 00:47:18:18 Robert J. I think, you know, if you're if you're doing an arch, one arch in an hour, you're already doing pretty well. And, yeah, if the how many, how many arches can we do in a day in a sustainable way? Because what another thing I think what I teach my, my, my mentees is about the mindset. Everyone wants to sort of do more and more, but protecting your sanity is something that's massively overlooked. 00:47:18:20 - 00:47:51:19 Robert J. And I think that's that's important. And if you can get that balance in early, that, that will serve you better. Maybe since I've had kids, I've, I'm starting to have these sort of reflections that it's not all about. It's not all about teeth. Even though the job that we do, it's you know, I talked about the addiction of the of the final result where you take some from A to B, but there's more to life than, than just our work. 00:47:51:19 - 00:48:21:29 Robert J. So something that I would like personally for myself is to sort of because I've been hustling for so many years, like today, I was just saying to my wife that it feels weird that I don't have to do anything. I've just been so used to vibrating at a certain frequency that actually being normal and not doing anything or not having to do anything is, for me, I feel a little bit strange. 00:48:22:01 - 00:48:43:13 Robert J. But yeah, for that, for my wife or someone else, they say, look, this is what normal feels like. So of course, you know, I've overdone it over the last years. So my advice to anyone wanting to do enter a career for large, definitely don't do it alone. Don't do what I did. Which is figure things out on your own. 00:48:43:14 - 00:49:08:20 Robert J. Find a mentor. Find someone who's actually been through the pain and the suffering so you can sort of shortcut your journey so you don't have to go through all of these crazy things that I had to go through. And then, yeah, just look after your look after your, your health and your and your body because, we have to perform like an Olympian almost every day. 00:49:08:26 - 00:49:45:14 Robert J. And recovery is very important. Getting good night's sleep, eating good food. That is key to all of this. So that's something I've been working on over the last couple of years. Because, yeah, there have been, as we know, in dentistry, there's it takes its toll on our health, on our backs, on our mental health. So that's why I'm guessing so open with sharing everything I have, because I don't want people to have to go through the painful journey that I've had to go through. 00:49:45:17 - 00:49:52:09 Robert N. It's powerful advice. Doctor Rob, thank you so much for being a part of this. Where can people find you in your classes and stuff online? 00:49:52:11 - 00:50:08:17 Robert J. Yeah, so I'm on Instagram at Doctor Robert Young and I have a website as well. Doctor Junco UK, so if I can help anyone then I'm an open book. So by all means, you know, fire away. 00:50:08:19 - 00:50:26:21 Robert N. Thank you so much man. This was such a cool conversation. Very inspiring. A lot, a lot of a lot of a lot of good advice there. And thank you, everyone else, for tuning into this episode of the Evolution of Dental podcast. Look for us on all the social media platforms as Evolution of Dental Podcast or streaming on all the podcast platforms. 00:50:26:21 - 00:50:37:01 Robert N. Release new episodes every Friday. Please remember to like, subscribe, share the show with your friends. It helps more than you know and remember. Never stop evolving.