Clear Aligner Treatment: Why Every Great Case Begins with the End | Dr. Melissa Shotell | EODP #35

00:00:00:02 - 00:00:25:03 Speaker 1 And I actually contend that work life balance, in my opinion, is a myth. It's essentially reverse engineering from the final point back to where the patient currently is to design the orthodontic tooth movement. I think patients like to see the technology when they realize that I had multiple 3D printers in the back of the office, they started asking if they could see them. 00:00:25:04 - 00:00:37:19 Speaker 1 I think whenever you teach, it makes you a stronger clinician yourself. 00:00:37:21 - 00:01:00:09 Speaker 1 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. Imagine being an orthodontist who moves the teeth, married to the proceedings, who rebuilds them, sharing one practice and one probably very opinionated dinner table. My guess plans the smile from final restoration backward. 00:01:00:09 - 00:01:14:14 Speaker 1 She built her first aligner course. That doesn't care what brand we use, and she'll tell you one part of your treatment plan that you should never hand your computer. Doctor Melissa Chatel on the aligner. Be herself. Let's get into it. How are you today? 00:01:14:20 - 00:01:17:04 Speaker 2 Great. Thank you. Thank you for having me. 00:01:17:07 - 00:01:27:09 Speaker 1 Thank you for being here. What did being a patient first teach you about orthodontics? That dental school never could. 00:01:27:12 - 00:02:01:00 Speaker 2 So being a patient taught me a lot because I had very complex, interdisciplinary care. So by the time I was about eight years old, I had my pediatric dentist, an orthodontist, and my oral surgeon overseeing all of my treatment. So it was a long process, and I saw the the complete journey and what happens from start to finish and what happens when colleagues and professionals work together for the benefit and the outcome of the patient. 00:02:01:00 - 00:02:34:04 Speaker 2 So I was really fortunate that I had a great team that took care of me, and then that really shaped my focus when I went to dental school. And yes, I actually did spend four years as a general dentist working in an interdisciplinary practice. We had in-house orthodontics, periodontics, and oral surgery, and doing all the restorative treatment for those cases made me determine that I wanted to go back to to school and study orthodontics, so I did. 00:02:34:07 - 00:02:44:10 Speaker 1 So given your background and your pretty unique experience, what are some restorative treatment plans that someone only trained in ortho would just walk right past? 00:02:44:13 - 00:03:23:18 Speaker 2 So I think so often we miss the opportunity to collaborate from orthodontics into the restorative space. And this can be anything from simple alignment to resolving rotations or resolving crowding to help with composite restorations all the way to positioning the teeth for a full mouth rehab or creating an ideal implant site. So I think because we often kind of practice in our silos as clinicians and practitioners and having to go between different offices, patients don't always want to leave their home office. 00:03:23:20 - 00:03:55:04 Speaker 2 I refer to the general dental practice as their home office. They don't want to leave and go outside of the clinicians that they know and that who who have been treating them so, so often. I think we either kind of walk past those interdisciplinary cases where we offer it to the patient, but when the patient gives a little resistance of, I don't want to go somewhere else, they don't really stress the importance to the patient and the optimal outcome that we can achieve when we work together. 00:03:55:07 - 00:04:06:22 Speaker 1 And so like most, most orthodontists, you know, they run into something like that. And they'll do they have to refer it out. You can just go to the next operatory right. What's an example where that really made a difference for you or the patients? 00:04:06:25 - 00:04:38:15 Speaker 2 Well usually the treatment is restorative driven. So typically it's diagnosed either in a new patient exam or in a hygiene visit. And usually, you know that's where the patient ends up staying is in the restorative practice. If the patient does take the initiative to go to the orthodontic office, I think the real challenge sometimes is missing the the communication of what the restorative plan is, because often patients come in and I'm like, well, what brings you in today? 00:04:38:16 - 00:05:09:08 Speaker 2 They're like, well, my doctor said to see you. So it's a huge advantage to have, you know, this specialties under one roof. However, I think there's so much that we can do to facilitate when we first identify that need to potentially collaborate with orthodontics, its first communicating that to the patient, but then communicating to the specialist exactly what's needed from the restorative standpoint. 00:05:09:10 - 00:05:16:10 Speaker 1 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. 00:05:16:12 - 00:05:35:14 Speaker 3 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. New episodes drop every Friday. Follow us on all the socials. You'll see all the latest content. Looking forward to seeing you there. 00:05:35:16 - 00:05:46:24 Speaker 1 When you do receive a referral. What do you think is the best way that other either you or other orthodontists could handle? Corralling all these different thoughts, opinions, and referral? 00:05:46:26 - 00:05:47:15 Speaker 4 I think. 00:05:47:16 - 00:06:17:16 Speaker 2 Usually, you know, over time you do build a strong relationship with certain referring doctors that tend to send those cases to you. And I think the best thing to do is to, you know, always evaluate the patient and see what you can accomplish, what you feel you can accomplish. Orthodontic li and then communicate with the restorative doctor what your plan would be, and make sure that that would be the positioning that they would want for the teeth. 00:06:17:20 - 00:06:52:03 Speaker 2 So usually, you know, the final position of the teeth is determined in advance of what, you know, we feel can be achieved. And making sure that that fulfills what the restorative doctor is asking for. I've unfortunately seen, you know, situations where, you know, in offices that I've worked in or cases that I've taken over where the restorative doctor wasn't consulted first, you know, they get to a beautiful orthodontic finish, and then the restorative doctor says, well, that's not where I wanted the teeth. 00:06:52:03 - 00:06:56:00 Speaker 2 And then that just means more time. 00:06:56:02 - 00:07:13:16 Speaker 1 Right. That was that was something that was kind of rattling around in my head when you were talking about that is like you have the lab, you have the restorative doctor. You have ortho and of course, the patient. So who ultimately, ultimately or ideally gets to decide where those teeth actually land. 00:07:13:19 - 00:07:39:26 Speaker 2 Ideally, I always say that the restorative doctor is the quarterback that they need to have their essentially their digital wax up or their, you know, traditional wax up done in advance of this is where I would like to restore the teeth to. And then consulting with the orthodontist to ask, can you move the teeth to this position? And if you can, it's fantastic. 00:07:39:27 - 00:08:05:03 Speaker 2 If you can't, then it's up to the orthodontist to communicate what you know, what we feel can be achieved, orthodontic and how much tooth movement we can achieve and communicate that to see if they can then modify the restorative plan to fit where the teeth can be moved to. So usually it takes, especially on full mouth reconstructions. It usually takes some communication back and forth. 00:08:05:03 - 00:08:17:20 Speaker 2 But in a restorative driven treatment plan. In my opinion, we need to have the complete restorative picture prior to beginning orthodontic treatment. 00:08:17:22 - 00:08:39:02 Speaker 1 Interesting. See, I live on the lab side of this handshake, and the lab usually gets the case well. After all, the teeth have already been moved and all these decisions have been made. So could you take us? Could you walk us backward from that? Could you tell us what that looks like? You know when when you're from the restorative or the ortho plan backward. 00:08:39:02 - 00:08:45:10 Speaker 1 And what is it? What is it you would like to see from the lab for? For the best results? 00:08:45:10 - 00:09:09:24 Speaker 2 I think the lab can be a tremendous help, either with the traditional or the digital wax up. So usually I would have the restorative doctor, you know, look at the patient and assess their treatment needs. Do they need, you know, the patient is partially missing a few teeth. And do they have, you know, something that's more esthetically driven like peg laterals or micro. 00:09:09:26 - 00:09:36:02 Speaker 2 And for the restorative doctor to communicate with the lab and to create a digital wax up or a traditional wax up saying, you know, this is what we would like for the the final restorative, you know, outcome to look like. And, you know, go ahead and move the teeth to, you know, the ideal positions after that's been created. 00:09:36:02 - 00:10:09:15 Speaker 2 That's a great time to bring the orthodontist in and to show the orthodontist that digital setup and to to say, you know, if we wanted to move the teeth into these positions to restore them, is this orthodontic feasible or where do you think we could bring this patient to, to aid in our restorative treatment and then make any, you know, modifications to the wax up is needed and then that can be utilized by the orthodontist to essentially look at the final product, look at the initial start, and then like aligners are done. 00:10:09:15 - 00:10:22:26 Speaker 2 It's essentially reverse engineering from the final point back to where the patient currently is to design the orthodontic tooth movement. So the lab definitely be heavily involved in this. 00:10:22:28 - 00:10:27:00 Speaker 1 Yeah, it sounds like the the digital wax that plays a pretty big role in your workflow. 00:10:27:07 - 00:10:53:15 Speaker 2 Yes, absolutely. And essentially whenever orthodontic treatment is started, we always a lot of us like to use the phrase begin with the end in mind. We want to design exactly whether whether it's combined with restorative treatment or just strictly orthodontic treatment itself. Design the final position for the teeth and then plan the different phases of the orthodontic tooth movement. 00:10:53:18 - 00:11:14:09 Speaker 1 Yeah, it's a that's a pretty good segue to in your June article, you used IPR to reposition the teeth for the final restorations, using fewer attachments and making for a cleaner midline. Can you walk us through from where it is going from that final backward, instead of like just looking at the crowding and going forward from there? Like, what is your process look like? 00:11:14:12 - 00:11:49:13 Speaker 2 I usually begin with full digital records, everything from the two sides, the mid lines. I spent a lot of time looking at the facial photographs, how much incisor display the patient has, where their smile arc is. Do we see, you know, dark spaces in the buccal corridors? And then, because I do a lot of clear aligner cases when I design the final position for the teeth, you can then reverse engineer back to your start point using the software and create the patient's aligner setup. 00:11:49:15 - 00:12:15:10 Speaker 1 That's beautiful. Now the other side of that and I'm sure you've seen this. I've seen it enough. And unfortunately I will be I'm man I've been a part of this. Sometimes a digital simulation can be a gorgeous liar. How can you. What do you what do you do to prevent creating a beautiful mock up? That the biology is a check that it just can't cash? 00:12:15:13 - 00:12:40:02 Speaker 2 You know, I think that's the biggest challenge. And especially when working with an, you know, any aligner software, if you're doing the setup yourself or if you're using what I think of as like the big box aligner companies, you know, the ones that all they do are, are produce clear aligners. And it is definitely movie daunting. So some of them use. 00:12:40:09 - 00:12:40:24 Speaker 2 Yes. 00:12:40:25 - 00:12:42:12 Speaker 1 That's right. You say movie daunting. 00:12:42:19 - 00:13:13:00 Speaker 2 Movie not X. Yes. Some of them use actually more like computer animation software. And they make a video of what the teeth will look like. Some of them are using the actual treatment planning software, but some of them are truly using like a computer animation software just to show you the representation. So really it's going back to to dental schools and understanding, you know, the biology of tooth movement. 00:13:13:06 - 00:13:38:22 Speaker 2 My favorite is when you see like a missing molar and they take the second molar and completely move it into the first molar position, you know, moving eight and nine millimeters. And, you know, they say it'll be done in a year. That's a really difficult, really challenging movement to do. Often it takes more than just clear aligners to accomplish a movement like that. 00:13:38:25 - 00:14:04:14 Speaker 2 But we have to understand that clear liner setups are not always created by orthodontics. There are some companies that have orthodontists that oversee them, but they're only checking certain treatment plans so certain things can kind of, you know, slip through. So you have to sit down from a clinical standpoint in really evaluate the setup and say, is that achievable and is that realistic? 00:14:04:16 - 00:14:27:13 Speaker 2 And I know I love all of my friends and colleagues in the lab industry. So I don't mean for this to sound inappropriate at all, but I always tell doctors I'm like, your treatment plan was done by an Xbox champion. Like somebody who is phenomenal at Cat. Like they're fantastic at it. You know, they use these softwares every single day. 00:14:27:15 - 00:14:44:12 Speaker 2 They can create a beautiful mock up for you. But what you have to bear in mind is some have a tremendous amount of dental training, some have a more limited amount of dental training. And it's looking at it and saying, is it realistic to actually make that movement? 00:14:44:13 - 00:15:07:09 Speaker 1 Frankly, I can't believe I hadn't heard this exactly phrase like this before. But Cristina, Rita, Lita, which I feel like I massacre her name every time I say it, but God bless her, she's an incredible technician. She's one of the exec at Heroes of Digital Industry, and we did an episode with her a few weeks back, and one of the things she said is there is no digital without analog. 00:15:07:14 - 00:15:32:25 Speaker 1 And I it really made me think about, like, the way that I learned dentistry. And as a technician and some of the trends I've seen with a lot of other, well, a lot of other technicians that are just exclusively digital, it never really have their hands on the actual cases themselves. And I feel like there's a lot of a lot of parallels from what you're describing there to to what she was claiming there as well. 00:15:32:26 - 00:15:56:20 Speaker 1 I mean, it's there's so much truth to it. You also your a reviewer for the Journal of Aligner Orthodontics. So you see claims that before they hit Instagram and before they're all over the internet and you see I'm sure stuff from very, very cutting edge work to things like we were just talking about where Xbox champions are creating things that may or may not be achievable. 00:15:56:27 - 00:16:04:21 Speaker 1 What's what's one thing that everybody repeats about clear aligners? This kind of gotten out of hand and way ahead of the evidence in your opinion. 00:16:04:24 - 00:16:36:13 Speaker 2 We're seeing that the push for AI, you know, companies are wanting to utilize AI. So you can definitely tell AI to find the contact points in the incisal edges of the teeth. But to me, that's the biggest concern, is that, you know, if you have, you know, a person who's sitting there, who's moving the teeth, who's checking it, depending on the amount of dental training, they might understand that it's not realistic to consistently close eight millimeters of space. 00:16:36:15 - 00:16:53:19 Speaker 2 However, with AI, if you tell it just to, you know, locate the contact points of the teeth and close all spaces, it will do it whether it's realistic or not. And then unfortunately that can get passed on to the clinician. 00:16:53:21 - 00:17:06:09 Speaker 1 Where do you feel like the where do you feel like the line is there for where the computer can't be trusted, versus you feel like it can be reliably handed off to to handle those tasks? 00:17:06:12 - 00:17:40:29 Speaker 2 I think from the software's that I've seen and that I've evaluated, AI is a great tool to do initial alignment. However, you need to always check ascetics and, you know, looking at the ideal alignment, it may not be flattering for the patient's facial type. So really evaluating how those teeth would look when positioned in that patients mouth and I it definitely it always comes down to clinician experience as well. 00:17:40:29 - 00:18:10:10 Speaker 2 Because when I work with a lot of doctors, you know so often they ask me, they're like, do you just accept the plan that you're sent? And I'm like, essentially never like, I can count on one hand in my entire career how many times I've approved an aligner setup without making some level of adjustment to it. And that's just a reflection of, you know, preference, evaluating the patient, wanting to customize the plan for the patient. 00:18:10:11 - 00:18:30:15 Speaker 2 So it's something that is more and more AI is integrated. I think we have a larger onus on the clinicians to really evaluate what they're looking at, because it may be machine generated and not generated by a laboratory technician. 00:18:30:18 - 00:18:38:18 Speaker 1 Yeah. No, I see what you mean. Exactly. And I mean, so you're the aligner queen, the aligner B, if you will. 00:18:38:20 - 00:18:42:02 Speaker 2 So I can tell you I can tell you where the aligner B comes from. 00:18:42:03 - 00:18:42:28 Speaker 1 Yeah, please. 00:18:42:29 - 00:19:09:02 Speaker 2 So a lot of people, you know, they'll they'll ask me about the B, they're like, well is it the aligner B are you the queen bee? And I'm absolutely not my first name. Melissa means honeybee in Greek. So my dad is actually 100% Greek and chose my name based on its meaning. So I needed a name that people would recognize, but a name that my patients would never find or that they wouldn't guess. 00:19:09:02 - 00:19:29:27 Speaker 2 Because when I'm not lecturing or teaching, when I'm not at the office, I don't want my patients to know I was looking for something dental, something fun, and it occurred to me that nobody would be looking for the aligner bead. And so since Melissa means honeybee in Greek, that was that was where the aligner bee came from. 00:19:30:00 - 00:19:52:07 Speaker 1 That's pretty clever. That's pretty clever. And then speaking of aligners, like what are what are some things that you can do now that you have that as a tool in your arsenal versus like traditional orthodontics with brackets and wires? And also where do you where do you see that that kind of falls off? Is there has there been anything lost or is it just all gains. 00:19:52:09 - 00:20:20:10 Speaker 2 Oh well, since clear aligners you know, we're brought really mainstream into the dental space just over 25 years ago. They had existed before that. And that's what I think a lot of people, you know, don't realize is that aligners had been being made since the 40s. So Doctor Nahum in the 40s designed his own thermo forming, vacuum forming appliance. 00:20:20:10 - 00:20:44:03 Speaker 2 He actually told us about it when he would present at Loma Linda. When I was a resident, he borrowed a Hoover vacuum cleaner from his mother, used like a large metal drum that you would use, like they would have stored like gasoline in at the time. And he used an iron to heat plastics that he had borrowed from a dry cleaners. 00:20:44:03 - 00:21:24:16 Speaker 2 And he started developing and devising the first, you know, methods to thermo form. But this was a strictly analog process. It was taking a stone model, cutting the teeth off of it, repositioning them, taking an impression of that, reporting it in stone. So essentially doing a reset model and then thermal mean that. And these are capable of very, very, very minor tooth movements as we've gone on this 25 year evolution over time, we went from clear liners treating those very, very simple cases to now treating very, very complex cases. 00:21:24:16 - 00:22:01:15 Speaker 2 And, you know, I personally attribute that to the advances in software, 3D printing. And really the thermo farming plastic with the aligners are being made from as well. So every year, you know, in my opinion, I, you know, see and decide to tackle more and more complex aligner cases. And I think every year, you know, we see more and more aligner cases, you know, increasing over time and being able to offer aligners to patients who wanted them, but that even 5 or 10 years ago might have been, you know, treated with bracket and wire. 00:22:01:18 - 00:22:48:20 Speaker 2 So there's always going to be a place for bracket and wire orthodontics. I think that that's really heavily dependent on the clinician. I know I myself, you know, I love using clear aligners, but there are cases that are very complex where I know that bracken and wire will be faster. For me, what I see is the most emerging part of orthodontics from that, you know, conversation debating between aligner versus bracket and wire is combining them for the best of both worlds into hybrid treatment and being able to produce my own aligners in office has really expanded and opened that aspect of orthodontics for me, because when I see very, very complex adult cases that might 00:22:48:21 - 00:23:11:20 Speaker 2 take a longer time period to treat in clear aligners, I can often do limited braces for 6 to 8 months, resolve most of my major crowding, or doing most of my major leveling that would have taken the longest in the aligners, achieved that in bracket and wire in a short amount of time, and then finish the case in aligners. 00:23:11:20 - 00:23:27:07 Speaker 2 And patients love that because instead of telling them we're going to take 2 or 2 and a half years in aligners, when I let them know that I can do 6 to 8 months in aligner or, excuse me, 6 to 8 months in braces and six months in aligners and have them done in a little over a year. 00:23:27:13 - 00:23:33:03 Speaker 2 That's that has been a huge transition and shift in my practice. 00:23:33:06 - 00:23:40:15 Speaker 1 So it sounds like it's a lot less of if either or and a lot more of a win and where. 00:23:40:18 - 00:23:49:00 Speaker 2 Yes, absolutely. Having an office 3D printing is really what's driven that transition for me. 00:23:49:02 - 00:23:54:01 Speaker 1 How has that changed it in your in your practice, how much do you use it and what do you use it for? 00:23:54:02 - 00:24:16:02 Speaker 2 Generally I use it all the time. So and you know, I do have a lot of patients that want to get done as quickly and efficiently as possible. And even if we only place braces on for a few months, that can take care of some of our larger tooth movements, then I can take off the braces, scan the patient, and finishing clear aligners. 00:24:16:02 - 00:24:42:00 Speaker 2 And for me, the real ability to be able to do that was to be able to control my cost with my own in-office aligners. Because to send to one of the major aligner companies for many years, you had to buy a package where it was, you know, ten steps or 20 steps or an unlimited number of steps, you know, for a certain time period when you were buying aligners. 00:24:42:02 - 00:25:03:13 Speaker 2 And now there are a few options where you can just pay per step. However, you know, traditionally, you know, you would end up with a very, very large laboratory bill, you know, for wanting to do just 4 or 5 steps of aligners. Now you can take the scan design, then 3D print the models, you know, make the thermo forms. 00:25:03:13 - 00:25:22:00 Speaker 2 And even some of the early forms of direct printing can be done in office. So it saves time for the clinician and for the patient because you're not waiting for aligners to arrive from the lab, but you also have the cost savings of producing them yourself in office. 00:25:22:02 - 00:25:32:00 Speaker 1 You teach this stuff now as well, right? You've you've incorporated it obviously into your practice very deeply, but you teach it to other clinicians. What's been very rewarding aspect of that? 00:25:32:07 - 00:25:54:21 Speaker 2 I think whenever you teach, it makes you a stronger clinician yourself because you have to really, really think through the process in detail. And then you also have to be able to answer questions. So there's always the concept of C1 do one, teach one. And it's one thing to see it and to do it in your own office. 00:25:54:22 - 00:26:21:03 Speaker 2 It's another thing to apply it into. Teach it outside of your clinical space. So, you know, teaching for me has been a fantastic experience. And I've taught this to, you know, clinicians, to laboratory technicians. And I work with the residents at UNLV in Las Vegas with a lot of their 3D printing cases. So it's it's been a very fun journey to go on. 00:26:21:06 - 00:26:34:21 Speaker 1 Is there something you do different now from when you started your teaching journey, like something you learned along the way that you've now incorporated in your practice, or how you treat or approach patients? That kind of shifted how you look at things. 00:26:34:24 - 00:26:54:08 Speaker 2 I think patients like to see the technology, and I've seen that over time that, you know, initially when I would have a set of 3D printed models and I would show a patient, the first thing they would ask me is, can I have those? And now I just know, like, you know, when I'm showing them their models, I always ask them, like, what would you like these? 00:26:54:08 - 00:27:22:25 Speaker 2 Or if they ask me sometimes I still need them for a little bit and I tell them, well, I need to do one more thing with these, but then you can have them next visit. And I, you know, of course, make sure to set them aside and, you know, make sure that they get them the following visit. But patients, when they realize that I had multiple 3D printers in the back of the office, they started asking if they could see them because, you know, so many patients hadn't seen a 3D printer or had it seen one in action. 00:27:22:27 - 00:27:46:19 Speaker 2 So there are like many times I've had to run to the back of a lab, move everything you know, that would have to meet you names on it so that I could let someone come back and see it. And if I had it to do over again. And I still may, you know, when doing some design, I would probably put one printer in a space that's visible to patients. 00:27:46:21 - 00:28:05:00 Speaker 1 People are fascinated by the technology. I mean, that's a big reason why I even got into this industry in the first place. Anyone who knows me or is listening to this podcast a couple episodes knows I'm a huge nerd, and the tech is what really pulled me into this in the first place. And like with my own little office here, right there in the front lobby is where I had my 3D printer. 00:28:05:00 - 00:28:14:04 Speaker 1 Because even if they have seen 3D printers, they don't really know, like resin printing versus other types. It's a whole it's Star Trek as far as they're concerned. 00:28:14:07 - 00:28:35:02 Speaker 2 Oh, my husband and I say, you know, we've we've seen the shift in our lifetime from when, you know, years ago, the cool kids were the jocks and the cheerleaders. And now it's truly that the nerds rule. And it's like most of us who consider ourselves dental nerds, like, we're really proud of it. And we wear it with a badge of honor. 00:28:35:03 - 00:28:58:21 Speaker 2 Like, I'm absolutely like one of my my friends from dental school one time told another friend, you know, when they were talking about, like, you know, digital dentistry, she's like, oh, I told her to call you up, that you're a total nerd, that you would absolutely answer your questions. And they're like, really? They're like, they. She was shocked that she would describe me that way and that it wouldn't offend me. 00:28:58:21 - 00:29:05:12 Speaker 2 And I'm like, no, like, this is this is something that you just have to embrace it at a certain point. 00:29:05:14 - 00:29:06:12 Speaker 1 Truly. 00:29:06:16 - 00:29:22:26 Speaker 5 I'm here with the sprint, right? Pro two. If you're considering bringing dental 3D printing into your practice or expanding what you already produce, schedule a meeting with me or send us a direct message. I'll personally walk you through the complete workflow and help you understand how it can fit into your operation. Now back to the show. 00:29:22:28 - 00:29:26:19 Speaker 1 Is there. Is there hobbies and other interests you have going on? 00:29:26:25 - 00:29:49:16 Speaker 2 I have a busy schedule, like I'm probably a terrible example of work life balance, and I actually contend that work life balance, in my opinion, is a myth, and it's something that we tell ourselves that we need to have. I think if you love what you do and if you're happy doing it, then you found your own balance. 00:29:49:19 - 00:30:20:06 Speaker 2 So I do, you know, I enjoy practicing, I love teaching. Teaching takes me to so many fun and fascinating places, and I get to meet really incredible clinicians. That being said, you know, when I'm home, I like to be home. I can be a bit of a homebody. And I actually have four sous. So I had two for a long time and just added two more to my pack or my four legged children. 00:30:20:08 - 00:30:40:21 Speaker 2 You know, when it comes to hobbies, like they keep me pretty busy. So, I don't necessarily have a, like, like a day to day hobby that I do every day. So I enjoy dentistry, I enjoy teaching, and I enjoy spending time with my zoos and my husband. 00:30:40:24 - 00:30:42:28 Speaker 1 We're a big fan of dogs on the podcast. 00:30:43:01 - 00:31:01:09 Speaker 2 Yes. It's in. It's really a challenge when your spouse is as much of a workaholic is. It's far. And I mean, we used to when we met in dental school, we used to always talk about like Friday night was date night in the SIM lab because we'd be sitting in there. So we had to do all of our own laboratory work where we went to down all school. 00:31:01:09 - 00:31:15:04 Speaker 2 So we would be sitting in the lab, you know, and setting, you know, mounting models on articulators and setting up denture teeth. And, you know, all these years later, nothing has really changed. 00:31:15:07 - 00:31:27:13 Speaker 1 For the for the doctors that are looking to make a change or curious about it, though, like the GP who's hearing this for the first time or has been clear line or curious, where would you say would be a good place for them to start? 00:31:27:15 - 00:31:53:20 Speaker 2 And they can always check out my online course and learn dentistry. I actually have learn aligners. I'm always happy and thrilled when I interact with doctors to say that they took my course and how much it helped them, and then, you know, work with other clinicians, join a study club, you know, attend and, you know, a dental meeting and take more education on the topic. 00:31:53:21 - 00:32:14:12 Speaker 2 So that's that's a great way to get started. If somebody is interested in 3D printing, I recommend that they kind of tackle using a major aligner laboratory first, because getting into doing your own design in your own 3D printing is is more complex. 00:32:14:14 - 00:32:26:06 Speaker 1 Yeah, it's it's kind of a big leap to jump in just blindly, especially depending on what you're looking to get into with 3D printing. Speaking of, you're pretty connected to to us here at evolve. How did how did you get introduced to Evolution Dental? 00:32:26:09 - 00:32:54:04 Speaker 2 So my husband, who is prosthodontics, Doctor Michael Scherer, and he met Josh Jackson years ago. And the two of them would really just sit and collaborate on ideas for things that weren't being 3D printed yet. And they were both really interested in 3D printing dentures. And there really wasn't a lot of technology available at the time to help with that. 00:32:54:06 - 00:33:20:24 Speaker 2 And so Josh and my husband worked together, and they sat around and really were trying to hack CAD to figure out how to make it do what they wanted it to do, even though there weren't any denture modules yet. And so they engineered what they wanted, and Josh would work on the design and help my husband, and then he would 3D print and deliver appliances to the patients. 00:33:20:24 - 00:33:32:14 Speaker 2 So it was a big collaboration. So then I eventually met the team at a ball, and we've all been friends and collaborated ever since. 00:33:32:16 - 00:33:43:06 Speaker 1 That's a that's a perfect match up. I mean, Josh's dad, Andy Jackson, the founder of the company, he basically invented digital dentures. So what the pretty, pretty natural segue there? 00:33:43:07 - 00:34:09:10 Speaker 2 Absolutely. I can remember my husband and the first time I, I, you know, had heard of Josh Jackson, my, my husband had something that he had been working on and trying and trying himself. And he asked Josh if he knew of any way to achieve what he wanted to do using CAD. And Josh is like, give me, give me a little bit of time to figure this out. 00:34:09:12 - 00:34:35:07 Speaker 2 And actually, overnight, he produced the exact models that my husband wanted emailed to him. And by that afternoon we had them 3D printed. So we had complete proof of concept of what could be done. But the the digital evolution, you know, it's it's been an amazing journey. I mean, we started years ago when really there was very little software available. 00:34:35:08 - 00:34:58:15 Speaker 2 We were having to use open source software. The first thing that we 3D printed in the office was a bleaching tray, the model to make the thermal form on and, and at the time I always tell everybody, you know, now you buy a 3D printer, it arrives in a box at your office, you unplug it, you set it on the counter, you you plug all the cords in and it's plug and play. 00:34:58:17 - 00:35:23:09 Speaker 2 Years ago, when we started on this process, you know, a box would arrive filled with parts and an instruction manual, and my husband and I would sit in the living room floor for three days assembling a 3D printer from parts. That was that's where the journey began. And, you know, there's there's nothing more fun than spending your your holiday weekend assembling a 3D printer. 00:35:23:09 - 00:35:27:00 Speaker 2 While this should watch you so. 00:35:27:02 - 00:35:33:06 Speaker 1 With instructions that you hope are actually correlated to the actual earner, which often they weren't at that time, I remember. 00:35:33:07 - 00:35:56:22 Speaker 2 Grew true. And I'll never forget one of them. Instead of sending like the plastic hood that covers the resin, it came this five pieces of plexiglass with a roll of electric tape. So it took one of us to hold them at the joints and the other one to put the tape on. And it was it was like a Lego set that you would get it half put together and then realize that something was a little bit askew. 00:35:56:25 - 00:36:23:16 Speaker 2 And, and I can remember, like, for instance, back when the moon Ray came out with Ray, all of a sudden I had like, this one, you know, clear plexiglass that I could take on and I could take off. And it was and it was just a novel concept that I didn't have to assemble it myself. And but, you know, we've we've watched the evolution of so many of the printer systems and we've tried so many of them. 00:36:23:16 - 00:36:44:14 Speaker 2 It's and that's part of the fun is seeing the new technology, seeing how there's a place for it. I know when people ask me how many 3D printers I have. I'm like a completely lost count and how many I've tried over the years. I've completely and totally lost count. And they always asked me, you know, from the orthodontic perspective. 00:36:44:14 - 00:36:56:08 Speaker 2 And I let them know, you know, orthodontics is pretty straightforward. It's when you really get into printing for Crown and Bridge, you get into printing for dentures. That gets much more complex. 00:36:56:10 - 00:37:22:06 Speaker 1 Yeah, I remember the moon ray very well, actually did an episode with a song busier a while back, which was awesome. Got to kind of reminisce over that, because I remember one of the things about it being lifting that big dome off, which was useful to have, but at the same time, it went from being one of the prettiest pieces of equipment in my lab to one of the ugliest pieces, because all those little resin fingerprints accumulated very quickly. 00:37:22:06 - 00:37:45:04 Speaker 1 Taking it up, taking it off, picking it up. It's been fascinating to watch the evolution of their of their products and going from, like you're saying, like they were definitely a big step up. I mean, they were a Kickstarter. And to go from that to a product that's essentially like opening an iPhone, you know, where everything's all included, you know, start to finish and all the components know what all the other components are doing. 00:37:45:04 - 00:37:46:15 Speaker 1 It's fascinating. 00:37:46:15 - 00:38:06:15 Speaker 2 It's been amazing to watch so many of the companies in 3D printing that have identified over time that the dental lab space is really perfect, you know, for 3D printing, you know, digital dentistry and 3D printing just go hand in hand. 00:38:06:18 - 00:38:32:00 Speaker 1 It's really they're really ideal for each other because it's the I mean, 3D printing is a 3D printing as a technology is a manufacturing technology is really that perfect intersection of very high precision and very low production output, especially for organic shapes. And, you know, anything that's other types of production outside of dentistry, like it just doesn't really apply nearly as well. 00:38:32:04 - 00:38:47:10 Speaker 1 Let's just prototyping. You just need five of one thing. Like you can't make an injection mold for that. What are you excited to see coming down the pipeline for technology, or what are you hoping to see? 00:38:47:13 - 00:39:19:25 Speaker 2 I think that over time, we're going to continue to see, you know, more evolution towards custom appliances. So obviously clear liners are customized per patient. But I think over time we're going to see more customization of, you know, the traditional traditional braces and brackets. Class two and class three characters functional appliances I think you know, everything that we do will become more and more highly customized over time. 00:39:19:25 - 00:39:45:25 Speaker 2 And I think it's going to be facilitated, you know, between intra oral scanning and digital treatment planning and 3D printing. So as we can print more and more materials, we'll just continue to expand what we're doing, because so many times, you know, at the moment a lot of appliances are like semi-custom ized. You might fit bands where you're finding the correct size, but they're not totally custom. 00:39:46:00 - 00:40:04:27 Speaker 2 You know, the appellate expander, there's a stock screw that's used and it's, you know, utilized, you know, on the bands you've selected. You know, we're getting to the point now that we'll 3D print some of the bands, but I think just the entire process is going to become more and more streamlined and more and more customized. 00:40:05:00 - 00:40:10:15 Speaker 1 I'm excited for that too. And this has been a really fun conversation. Thank you for being here. 00:40:10:22 - 00:40:13:24 Speaker 2 Excellent. Thank you so much. Thank you for having me. 00:40:13:26 - 00:40:20:15 Speaker 1 We're so where can people find you online and and where again, can they sign up for your courses. 00:40:20:18 - 00:40:50:04 Speaker 2 So they can find me on Facebook and Instagram as a liner be I'm on LinkedIn as Melissa shoutout and they can find my online course. I have a comprehensive aligners course as Learn Aligners that is on Learn Dentistry. Com and I actually have a full in-office 3D printing course as well. For those doctors that want to begin 3D printing and fabricating their own aligners in office. 00:40:50:07 - 00:40:59:02 Speaker 2 So check out the Learn Dentistry website. Those are there. In addition to some of the blogs that I've written on orthodontics and 3D printing. 00:40:59:04 - 00:41:00:25 Speaker 1 Excellent. Thank you again. 00:41:01:02 - 00:41:04:01 Speaker 2 Excellent. Thank you. Thank you for having me. It's been a pleasure. 00:41:04:03 - 00:41:27:06 Speaker 1 Likewise. And thank you, everyone else, for tuning in to this episode of the Evolution of Dental Podcast. Please look for us on all the social media platforms as Evolution of Dental Podcast. We drop new episodes every Friday. We're available on all the podcast streaming platforms. Please remember to like, share the show with your friends and subscribe. Subscribing helps more than you know and remember. 00:41:27:07 - 00:41:28:25 Speaker 1 Never stop evolving.