Critical Thinking in Digital Implant Dentistry | Dr. Adam Kimowitz | EODP #42

00:00:00:01 - 00:00:17:54 Adam Don't be afraid to tell me I suck. Like, don't be afraid to tell me if you see something. Clearly you're calling for a reason. You want an implant. But what makes you feel like. Are you. Are you in pain? Are you having trouble chewing? I want to understand how this is impacting you. And then what would Dunn look like? 00:00:18:03 - 00:00:38:25 Adam How do we course correct to keep this person safe? Okay. And and exercise judgment to not get about us about revenue. But more. So what's the best for that person? 00:00:38:30 - 00:01:02:34 Rob Welcome back to the Evolution of Dental Podcast, brought to you by Evolution Dental Science, where we share the stories of the people and the technology shaping the world of dentistry. I'm your host, Bob Norton. My guest today places and restores hundreds of implants a year in his practice. His dad opened in 1975, and he's on the board of exam for other implant dentists that, you know, maybe lose sleep over. 00:01:02:39 - 00:01:15:03 Rob He doesn't believe in hopeless mouths. And he has a fascinating story and a take on dentistry well beyond just placing teeth. Doctor Adam Kim, welcome to the evolution of the Holocaust. How are you? Oh, me. 00:01:15:03 - 00:01:21:08 Adam Adam, I tell everyone who call me Adam. Doing really well. Psyched to be here. Very. 00:01:21:10 - 00:01:45:46 Rob I'm so glad to have you. The. So, one of the things, one of the things we have in common is coming up in, in and around our parents as entrepreneurs, as having their own business. So I came up as most people who watched this already know with my parents dental lab supply company. Yeah. And, you know, business and how that was, was whether or not I was involved in the business as a young age or older. 00:01:45:54 - 00:02:02:49 Rob Always a conversation at the dental, at the dinner table. So here's my theory. Dentistry was not the hard part for you that the day people could asking for your dad instead of you in the practice was probably the harder transition. Or how close am I? How far off am I. 00:02:02:51 - 00:02:19:38 Adam Your spot on. It's even. It's a little deeper than that. My dad started, like you said, in 1975, in a small town in new Jersey where there like four dentists, he had worked for a World War Two dentist, you know, came World War Two, opened up shop and real, real family independent practice. Not big than these big groups today. 00:02:19:39 - 00:02:37:54 Adam It was, you know, you see people in the supermarket and everywhere else. And, you know, I kind of grew up with that. And what was really cool was, is that beyond the dinner, it was like I was able to have a very present dad. So if I had a football game or something that mattered, he's like, I'm going to shift the schedule so that I can be there for you when it mattered. 00:02:37:56 - 00:02:56:51 Adam And, you know, my mom helped out in the practice. I had two brothers that again felt that. And it wasn't the stuff. It was the presence. Right? It was the time. So we were very connected in that. And I and I kind of looked at and my, my dad's awesome, right? Just like one of the coolest guys ever, you know, doesn't ever take himself too seriously. 00:02:56:56 - 00:03:16:20 Adam Likes to laugh. Has really into puns like, you know, he was the OG of dad jokes, you know, so I basically when I, I didn't always want to be a dentist, actually, just all I wanted to do was make money. So what I did, I got an economics degree and worked at PricewaterhouseCoopers. After college, I didn't go right into dentistry, and in my early 20s I was just like, you know what? 00:03:16:20 - 00:03:40:56 Adam This just doesn't make me happy. You know, like buying stuff and things. And then kind of September 11th happened, which I think anytime something big happens, it makes people question. And, you know, we all have our stories with it. But essentially I said, you know, what, if I was working in this corporate job for in my 50s, 60s and 70s, would I be happy and have the agency to do what my dad could do in terms of being there? 00:03:40:56 - 00:03:57:32 Adam Time wise people would get laid off high performers, but not because they didn't perform well, but because a business decision was made in the boardroom across the country. And that was like, I had no agency. And I'm like, well, I don't know if I want to get involved with a life where my performance had nothing to do with it. 00:03:57:32 - 00:04:14:18 Adam And then also I was helping people, but not the way my dad did. He really changed lives. And I'm not saying like a feeling or this what he did, but like, you'd see people and be like your dad, you know, allowed me to go to my son's christening because I broke a tooth on a, you know, you hear these stories and that's really impactful. 00:04:14:20 - 00:04:29:44 Adam Like, really as a kid, you're like, you know, it's kind of like, my dad's my hero, right? So like, and my 20s, I'm like, I kind of want that, right? And then he's like, I said to my dad, maybe, maybe I'm thinking 26 the think about becoming a dentist. And he's like, you can't just flip a switch and become a dentist. 00:04:29:46 - 00:04:48:58 Adam You have to actually go to school for that. And I'm like, I know. So I actually took a leave of my job. I did ergo biophysics and chem. In one year, got into dental school and I kind of bit the bug. And then you ask about implant dentistry. You know, it was really unique because he practiced at a time. 00:04:48:58 - 00:05:13:10 Adam He placed his first implant in the 80s. And the cool thing is, is that, like a lot of people who he served generations ago still come with parts and systems that don't even exist. And I know how to still restore them. Right. You know, even if it's making custom parts and doing some funky stuff. So I'm very interested in that history of implants and where we were and where we are now, and the reason why he got into it. 00:05:13:25 - 00:05:35:42 Adam It wasn't that I want to place titanium, and I want to be this rock star dentist and fill my balance sheet. It was like, you know, he's like, I saw these people when I was in dental school that they were relegated to partials and dentures. And the emotional outcome of these treatments, really, we're devastating for people, right? And he's like, and I felt like we could do better if someone was in my family, what would I want? 00:05:35:44 - 00:05:53:03 Adam And he saw implants. Is that possibility. So people that typically would have been taking teeth out, putting it on a plate, he was now giving them their life back. You know, if you translate it and compress it to that. And I basically said in dental school, you know, and I in early two, early 2000. So I'm like, this is really what I wanted to do. 00:05:53:03 - 00:06:10:20 Adam So I went right from dental school to an implant fellowship. Finished that. And then 20 years had been doing it ever since. There's so many great people that are inspiring that we can learn from and help, and that for me, I'd be nothing without my dad and the people that taught me. So that's where I got an education. 00:06:10:20 - 00:06:26:18 Adam It's like I want to get back, you know? So it's it's been a wonderful, wonderful, wonderful profession. And it has connected me to great people, my family, my team, folks like yourself, evolution. You know, there's just there's a lot of awesomeness all around and there's a lot of tough. There's a lot of tough spot. 00:06:26:22 - 00:06:28:25 Rob What? How did sorry. I mean, the interrupt, you. 00:06:28:27 - 00:06:28:56 Adam Know, but. 00:06:29:03 - 00:06:32:22 Rob Yeah, that's a story. I don't know, actually. How did you get connected with evolution? 00:06:32:27 - 00:06:53:30 Adam So interestingly enough. So maybe about 15, 12, 13, 14 years ago as a part of a group called Smile source. And Smile source. There's so a few different parts. Right? So I got to see Andy and Josh and all the things that they were doing digital and like these guys are really onto something. They really were, for lack of a better word, evolutionary and revolutionary. 00:06:53:34 - 00:07:00:58 Adam Because the old mindset was, was the lab felt that there was going to be a mass takeover, you know, oh my gosh, it's going to, you know, take us, you know. 00:07:01:01 - 00:07:02:42 Rob So I remember that very clearly. 00:07:02:46 - 00:07:04:56 Adam Yeah. And it's like it's coming from the lab. 00:07:05:01 - 00:07:07:34 Rob Side of things especially. Oh yeah. 00:07:07:44 - 00:07:28:42 Adam He embraced that. And he's like, no, I want to help them just understand this better because we want to play a part of that. You know. So we're not bigger than this. We just play a role in this. So Andy saw that not as a threat but more so as an opportunity. So we partnered up and we did some really cool cases because I kind of was brought in to this implant world, in the analog world where digital was starting. 00:07:28:46 - 00:07:55:14 Adam So where I feel not that I feel bad for people in education now, but if you don't understand both ways of doing it, you don't build the context, right? So there are times that I do analog stuff, digital, I mesh the two, you know, with all of it. So it was really cool to kind of start these cases because I'd been doing guided for since literally like Nobel called it Nobel clinician, Nobel Prize. 00:07:55:25 - 00:08:16:27 Adam We'd have to send stuff to the lab and they'd scan it in and back and forth. So been doing it since like day one. And I've learned I'm not good. I've just learned everything the hard way and then hopefully learned from it. So I met Andy and he embraced it, especially with the digital dentures and everything else. And I was just like, not only are these guys good, you know, technicians, professionals, they're good people. 00:08:16:32 - 00:08:36:46 Adam And I want to align with good people. You know, these guys are just good vibe, good feels great work. They care about the product. They they they care about their people. They care about delivering results of where people are at and they don't make you feel bad. One of the things I always tell my lab is I said, listen, don't be afraid to tell me I suck. 00:08:36:51 - 00:08:53:44 Adam Like, don't be afraid to tell me if you see something. Maybe I was woke up on the wrong side of the bed. Like that will only make me better, right? Don't be afraid. Because a lot of lab technicians are afraid that they're going to affect doctor egos, right? They're going to be like, oh, I. 00:08:53:49 - 00:09:06:58 Rob Go or they're afraid they'll lose the account. Most labs, the account, newer owners who went from working at a bench somewhere to now, they started their own lab are terrified of upsetting the doc, losing the account. But what. 00:09:06:58 - 00:09:07:06 Adam You. 00:09:07:06 - 00:09:08:30 Rob Just said, they're so powerful. 00:09:08:37 - 00:09:27:49 Adam Yeah. And I'm like. And I said to Annie, I'm like, first before we even say, how much is your abutment? Like, I don't care about that. I want to establish a working relationship with you first. Philosophically, if I suck, tell me, like, I want you to tell me every shortcoming, how I can improve what, because that's how I learn, right? 00:09:27:58 - 00:09:48:20 Adam Great. I don't mind, you know, because you know what? Next time it's not going to happen. Or at least, you know, I want to know what I did, because I don't know what I don't know. So through that, a really good working relationship developed, collaborative. Not here. How much for this make this for me. But no, Adam, I am entrusting you to give me something to make me successful. 00:09:48:20 - 00:10:17:03 Adam And Andy, you know, and you know, Josh and whoever I'm like, and you know, you are unbelievably important. And the part of the team for care delivery. And we have to work in that way. And like that's that whole concept of psychological safety. Right. So safety is not this kind of kumbaya sound bass, you know, aromatherapy thing. But it's the concept that if you're on the team of really, really, really important engineers working on the challenger shuttle and you don't mention a screw loosening, people are going to die. 00:10:17:15 - 00:10:35:44 Adam If you're in an operating room setting and you don't say to that surgeon, you left an instrument in somebody's thoracic cavity, somebody's going to die. So and without fear of reprisal. And I'm not saying the stakes are that high in implant dentistry, but in terms of effective collaboration with teams, you got to have that psychological safety in place in order to get good outcomes. 00:10:35:46 - 00:10:58:58 Rob I'm going to push back just a little bit on that. It is that important. I'll say that because it nearly killed my mother, 7 or 8 years ago now. Doctor who will not be named here, left a bone fragment, which again happens. He kept treating it with antibiotics over and over and over again. This went on for a year until the infection spread almost to her heart. 00:10:58:58 - 00:11:04:22 Rob And she was in the E.R. and, shout out to Doctor Bagheera, who actually saved her life. 00:11:04:27 - 00:11:04:58 Adam Yeah. 00:11:05:10 - 00:11:22:39 Rob Thank God for him. And thank God she did get the care she needed. But yeah, it does matter, like you're saying, because it really is that important. Small mistakes can compound. You have to pay attention to these sort of things, because sometimes it really can spiral out of control and into a life threatening situation. 00:11:22:44 - 00:11:40:58 Adam Correct. In those blind spots in our egos really just don't benefit anyone. And I tell my assistance to I'm like, if I don't do something or you see something I'm leaving behind that can hurt someone, do not be afraid to share with me. I will thank you. I will be grateful for you. Right? Because what it does is it spares you, me, this person, the terrible outcome. 00:11:41:03 - 00:12:04:58 Adam My ego has nothing to do with this. A good outcome is what it's all about, you know, and I think from that point, for perfect example with your mom, right? It was the ego and the blind spot that caused her to have this. But it's everything that's psych safety in what we do. Even with my lab relationships, in my surgical surgical settings, it is so important to have in place that you know that that's just imperative. 00:12:04:58 - 00:12:22:25 Adam So that's so when I got involved with evolution, I'm like, these guys are wonderful. And it's been just such a really just good relationship built on that. I'm not perfect. The lab is not perfect. We're going to make mistakes. You know things are going to happen. But it's not about the mistakes. It's about how we work together to get through it. 00:12:22:30 - 00:12:28:01 Adam And the only thing that I really have a problem with, not lab or anyone, is just lack of integrity and honesty. 00:12:28:10 - 00:12:37:58 Rob I couldn't agree more. Is that is that collaborative? Is that what led you to wanting to adopt some more, this technology in your own practice? 00:12:38:03 - 00:12:55:37 Rob 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 notification bell if you're watching on YouTube so you can get notified of our new episodes. 00:12:55:44 - 00:13:03:58 Rob New episodes drop every Friday. Follow us on all the socials. You'll see all the latest content. Looking forward to seeing you there. 00:13:04:03 - 00:13:19:00 Adam Everyone wants to travel to a nice destination. Let's use Florida, right? You can walk there. You'll get there, right? You can take a horse. You'll get there too. You know, you could drive or take a train or you know me, I want a direct flight because I'll get there in two hours. Right. You'll still. But the journey is very different. 00:13:19:01 - 00:13:37:44 Adam So same thing with technology. I saw the way that my dad was doing certain things and the way I learned in dental school and like, yeah, we're getting to an outcome. I can make a denture, set, a Rex rim, use green stick compound, set teeth, do all that, or I can do a digital denture. Dial it in. Get something a lot more accurate, detailed, right. 00:13:37:46 - 00:13:56:20 Adam Better material because I'm milling it. Right. So still getting the denture. Same product. The the the journey is very different. So what I saw in digital was an opportunity. So it's not digital for the sake of digital. It's for the it's it's I saw opportunities right. But I also believe sometimes people do digital for the sake of digital. 00:13:56:27 - 00:14:18:23 Adam I like to study and see and understand and compare. And I'm very big on a B testing. So like not a full arch case. I don't just do it all digital. I will always take records. I always do analog records on a full case because you cannot get good tissue with a scanner. And what I mean, you can get good tissue, you can't get the stimulus extensions, you can't border mold. 00:14:18:23 - 00:14:36:03 Adam I want to find a scanner that can border mold. So and sometimes those peripheries are everything. And understanding where that vestibule goes. So understanding those things and then comparing the digital and the analog. So we do an a b. Now we have delayed records because when the stakes are so high it's worth it. So that's where we marry the two we get. 00:14:36:06 - 00:14:55:06 Adam We digitize that impression. So I always look at it as the opportunity the possibility. And then is it worth, you know, is the juice worth the squeeze. Right. The cost of ownership of that technology. Right. Sometimes people want to go full on X. Okay. I'm going to be the lab. Stay in my office till three in the morning designing this case. 00:14:55:06 - 00:15:15:49 Adam Or I could say, listen, you know what? I'm going to have these guys at evolution who live in Exo CAD 247 do 98% of the design do a lot of the booleans? A lot of the things, the segmentation, you know, and then because they are really the thought leaders and then I'm going to go back to the design, tweak it in the way that I want and boom. 00:15:15:49 - 00:15:27:44 Adam So it's like that's the kind of so but again, I used to be that dentist that used to stay till three in the morning. Right. I'm not doing that anymore. So it's really understand philosophically where you want it to fit in your life and where it where it means something. 00:15:27:56 - 00:15:45:37 Rob We had we had an episode a little while back with Christina Vitality, who's a one of the heroes of digital dentistry and a thing that she put into words that I had had my brain but never really convinced down into just a few words was there is no digital without analog and. 00:15:45:42 - 00:15:48:06 Adam And 50 million, percent, one. 00:15:48:06 - 00:15:49:27 Rob Hundred million percent. Right. 00:15:49:30 - 00:15:49:39 Adam Yeah. 00:15:49:42 - 00:16:10:06 Rob And I see that as somebody who the real thing that got me into dentistry all together was certainly not watching us sell boxes of gypsum powder out the back door of the company. It was the technicians and especially the technology that kind of came together around the same time. So I'm a big tech guy. I'm a big nerd. 00:16:10:11 - 00:16:28:23 Rob And so if there's a digital way to do it, I'm a thousand. I'm going to go out of my way, maybe work harder to do it digital. But at the end of the day, if you don't have the analog fundamentals there, then you have no way to ground it. Some of us need it more than others, but end of the day, like what you're saying is correct there. 00:16:28:27 - 00:16:38:13 Rob It's I can cite numerous cases related to that with the with the technology you've adopted, though, what do you feel really move the needle in your clinical work? 00:16:38:27 - 00:17:01:44 Adam I wouldn't say it's the technology per se. It's my mindset as it relates to the technology. When I initially started adopting digital, I said, it's going to solve everything I poured, you know? Right. It's going to solve everything. It's going to answer everything. So let's just say when the early scan bodies came out and I basically want to get a screw retain multi you know multiple unit things. 00:17:01:44 - 00:17:22:20 Adam And then like why is this not freaking passive. Right. And why are these screws binding. It's supposed to be digital. It's supposed to solve everything. Right. But what we didn't understand at the early point was tolerances and geometry and everything else. And hexed and non hex. So and then why do we do verification jigs tier side and spend all these you know things doing verification jigs. 00:17:22:20 - 00:17:47:32 Adam So what I said to myself it's I can understand what it does and what it doesn't. So now what I understand it's tolerances its limitations. It's not my mindset is it's not digital. That's going to solve it. It's my philosophy on capture. Understand. So what I understand it's like on. So when the complexity gets up I need to validate with digital and analog or two points of digital capture. 00:17:47:35 - 00:18:09:25 Adam The concepts are what are the most important. So I'd say for a younger clinician that's like digital solves everything. You just scan it, tend to the lab, get a tooth grade. You don't. It doesn't necessarily understand the under the underlying principle of biomechanics, the underlying principle of what timing on a hex platform versus a, you know, non hex platform like a conical. 00:18:09:27 - 00:18:26:49 Adam It doesn't get them to understand inclusion better. It allows you to see the things that digital can emerge with this. So I think it gives us better data for our brain. And that's where when I started and that's where I really started to appreciate the technology as opposed to just saying, oh, it's going to do it for you. 00:18:26:51 - 00:18:45:23 Adam Just like put it into AI, what do you get? You get slopped, right? Unless you know yourself, right? You know that old Socrates know thyself, right? If you know yourself really well, you know your concepts. You know how your patient presents. You know the diagnostic criteria for a good outcome. That patient A, maybe a terminal patient. But why are they terminal? 00:18:45:25 - 00:19:09:06 Adam Because they're a Brock's or the other patient B may be terminal because they're a patient very, very similar terminal diagnosis but very different prosthetic implications on delivery. You know what. Three months later every fricking thing has failed. And you say, why wasn't digital supposed to solve everything? No, it just put something in. You had to put the you have to tether the thinking to the digital, the thinking to the analog. 00:19:09:11 - 00:19:33:49 Adam So this is where that lab doctor collaboration comes in place. What matters to me most is the thinking behind these cases, not just on surgery, day of delivery, on milling, on the beautiful ceramics. But how does that pass muster in ten years, 15 years, 30 years? And then they're going to come back for a revision? Or do I call the lab and say, your implant failed or the ceramic? 00:19:33:49 - 00:19:57:03 Adam But no, you know, so it's not like there's a best material or worse material. It's what material, what fixture, what prosthetic scenario is ideal for this unique patient, and what tools can I bring in to achieve the solution. And that's where I think we're like digital, digital now. Everything is a freaking tool. Our brain is the ultimate tool. 00:19:57:08 - 00:20:16:37 Rob I'm here at one of our exo cab design stations. If you're looking for greater control and flexibility within your digital design workflow, schedule a meeting with me or send us a direct message. I'll personally walk you through Exo CAD help you understand the available options to choose the right configuration for your lab or your practice. Now back to the show. 00:20:16:42 - 00:20:36:23 Adam And that's really where I think when I realized that, I said, okay, every tool is just a piece of a Lego. It's just a Lego. The architect is the lab and the clinician and the patient assembling a narrative, you know, and that's what I'm not trying to poop on a clear choice or these big implant centers, but, you know, and that works. 00:20:36:30 - 00:20:51:49 Adam But everybody is different. Like, I'm looking at all the downstream effects of the choices we make from not just capture technologies, but delivery technologies and functional. So that's kind of so I know I'm getting philosophical here, but that's kind of how. 00:20:51:49 - 00:21:11:06 Rob I know that's exactly the right way to look at it, I think. Yeah, I really, really appreciate what you said there with the with the change in mentality. Yeah. Anyone who's ever taken one of my XO CAD courses, which by the way, shameless plug. Sign up with the link in the bio. One of the things I say all the time is like the the technology is incredible. 00:21:11:13 - 00:21:27:49 Rob The software is so powerful, but at the end of the day, it is just a tool. And a screwdriver does not care if you're driving a screw or prying open a paint can. It's just a tool. It just depends on how you use it and how you think about it. So I really like I really like how you kind of brought that back around. 00:21:28:03 - 00:21:44:54 Adam With them to patients, especially on console. Well, how much you know, how much for a crown? I'm like, it's not a utility. How much for an implant? It's not a utility. It's not the plane. It's the pilot. It's not the ship, it's the captain. Right. So it's the right tool, right? Just because you pick that card doesn't mean you're a good driver, and it's going to serve the utility that you needed. 00:21:44:54 - 00:21:56:39 Adam So that's the point of your X okay class. You can teach people to the blue in the face. But if they don't understand the concepts at which to apply that XO CAD capability, it's not going to matter. 00:21:56:44 - 00:22:18:32 Rob Absolutely. The the mentality there is everything. And so that kind of brings me around to, well, the headline of your website, which, which reads out as you can be very good at your job and still be a mess. Yeah, we touched on this a little bit before we started recording. But yes, for those who for those of us who weren't privy to that before we started recording, what does that mean? 00:22:18:47 - 00:22:21:02 Rob Where did that come from? 00:22:21:06 - 00:22:49:59 Adam It's it's really interesting and it's kind of evolved. I'm throwing throwing it upon their evolved. Sorry. But basically in 2019. I was director of a maxi course for the American Academy of Implant Dentistry. I was very involved with education, teaching for a few other labs, speaking for Bio horizons, acting on a few different companies. And I was on that like hamster wheel of a lecture circuit, wanting to build up my professional resume and really just kind of wanting to get out there and, you know, in 2019. 00:22:50:01 - 00:23:09:51 Adam My brother was murdered, somebody broke into his home, and my brother was my best friend. And, as you can imagine, whether it's even murder or anything, insert a traumatic event in someone's life that is a tectonic shift in the way you see the world, you know? So on that day that I found out, it was just it wasn't even like, how do I become a dentist? 00:23:09:51 - 00:23:27:56 Adam It's like, how do I not throw up? Like, literally how do I, like, keep a meal down? How do I literally go from one minute to the next without breaking down on every second? And then, you know, then I, I had to plan a funeral. I had to do all these things I had to do with prosecutors. I had to deal with a criminal trial. 00:23:27:56 - 00:23:50:18 Adam And I don't really want to get into the dynamic of that event. You know what's more important for me, and this is what I started to talk about, is, is that what people see is the event, what most people don't see from the Netflix documentaries are the stories that affected the people associated with the events. So for me, it's about telling the story and also keeping David alive. 00:23:50:18 - 00:24:07:06 Adam Not in the true literal sense, but metaphorically. You know, me connecting to my brother is talking about him. So anyhow, in those early days, you know, I'll tell you a little story. There was a, you know, I had just told my children, I have three kids, and my wife Mara, who's like my favorite person in the world. 00:24:07:06 - 00:24:26:13 Adam My kids were young at the time. Son Nathaniel wanted some goldfish. It was three days after it happened and he asked me for some goldfish. So I went to the kitchen and got goldfish. And I picked up the box and the goldfish kind of fell all over the floor, right? And normally think, okay, you pick up goldfish. So I get down on the floor and I'm trying to pick them up, but I couldn't pick them up. 00:24:26:13 - 00:24:48:11 Adam And I just started crying because metaphorically, that mess of goldfish was a greater mirror to that Adam year of frickin mess, right? So I lost it, and I said to myself, if I can't even pick up goldfish, how am I supposed to go place an implant? I went in to the office. I actually had an implant on my schedule ten days later, and I actually, it actually was a single implant and I was able to do it. 00:24:48:11 - 00:25:07:08 Adam And what I actually found out was in that moment, it didn't eliminate the fact that my brother had died, but I was really present and really focused on the patient and the implant and that flow state of and it didn't a race grief, but it just kind of allowed me to know that grief couldn't coexist with Adam the dentist. 00:25:07:08 - 00:25:26:49 Adam So I'm not just defined by grief in the moment, and that I'm more than just the guy with the murdered brother. I'm also an implant dentist. I'm a dad. I can laugh at jokes. You know I can. I can have multiple parts that don't necessarily conflict, and it doesn't take away grief. So what I thought at the time was like, oh my gosh, dentistry is a vehicle that saved my life. 00:25:26:51 - 00:25:44:59 Adam Like put me to work, really focus on clinical care. And interestingly enough to you. And I'll tell a story that I'm actually with him right now. Don't know if you know Justin Moody. Justin's a really close friend of mine, and he flew in from Phoenix, and during the funeral he texted me and he asked because there are about 2000 people in the house. 00:25:45:06 - 00:26:09:25 Adam My brother was very involved in the comedy. He owned a comedy club called The Stand. And my family's still involved with that. And he was a comedy producer for Jimmy Fallon. So he asked me earlier if I was a comedian. I'm actually going to be monologuing about my brother's story at New York laugh this June. So, so anyhow, he came during the funeral, 2000 people in the house, the press was everywhere. 00:26:09:25 - 00:26:28:30 Adam And he sends me. He's like, listen, he seemed to be really connected in this place. Can you ask him to turn the AC down? Right. And I look at this and I just started laughing. Right. So it's like, how do you laugh during your brother's funeral? Like, how effed up was that? But it wasn't. Right, because it's so reminded me that I was a person that has a sense of humor. 00:26:28:37 - 00:26:44:30 Adam And it didn't take away from the grief, but it reminded me that I was still Adam, right in there somewhere. That Adam, who can laugh, is still there even though he's grieving. But it reminded me of that humanity, and I think it was like the biggest gift that anybody can give someone is that you don't have to carry this alone. 00:26:44:30 - 00:27:05:59 Adam You're not defined by that. So what I then did was kind of really dive into resilience thinking and and saying, like, I'm not okay right now. I know I'm not okay and I'm okay with not okay, but I want to work to become okay, better, you know, and and really just more intentional with living a better life because I couldn't change the fact that my brother was killed. 00:27:05:59 - 00:27:24:27 Adam I just couldn't, you know, and there's a lot of it that was, you know, again, I'm compressing because seven years ago, if I'm so heavily defined of Dennis, she's the only thing in life that defines me and that's taken away. What what am I? Who am I? You know, and I'm really more fascinated in the person behind the performance. 00:27:24:35 - 00:27:55:13 Adam Meaning you could still be good at your job, that performative self. What we see on Instagram, what people put out there for likes. But there's a lot more underneath that that we all don't see and know. And I'm really, really, really interested these days, having conversations with high powered clinicians, military folks, attorneys, people that own business, you know, anybody in the world that has to balance a life on the outside and then the inside. 00:27:55:18 - 00:28:23:16 Adam And we see so many bad outcomes here. And I and I don't want to get two, dark here, but we all probably know people that have dealt with addiction, right? Suicide, bad stuff. It's real and it affects us. And and to ignore it also just makes us to have, you know, it makes our ability to cope with the things that we have to do more challenging. 00:28:23:16 - 00:28:51:35 Adam So I'm looking for ways for myself and also to share my story, to use it as a professional mirror. So the reason I did this talk, it's called murder, resilience and dental implants. It's not that I'm okay, it's that maybe I am still a mess, but I'm okay with being a mess. But acknowledging that building support and understanding where connections really are in the world doesn't fix the problem, but lets you know that you can move forward and go through it and that you don't have to carry it alone. 00:28:51:37 - 00:29:09:52 Adam I have a friend who's a psychologist, and I was on his podcast a few about a month ago. Adam Dorsey wrote a book about connection. He talks about the four types. Right? Connection to yourself, connection to others, connection to your environment, and then connection to something greater. Why do I do dentistry? Because it impacts people and it really changes. 00:29:09:54 - 00:29:34:06 Adam I feel it's impactful changes or lives. That means something, right? That means something that's really, really, really important. So after David's death, it's how did I find ways to live better? Acknowledge where I'm suffering, acknowledge where I suck, acknowledge where I'm in pain or where things are not clear. And I'm okay with not clear. You know, and you know, I'm looking to just create more awareness and lower some barriers in that. 00:29:34:06 - 00:30:00:01 Adam So it's very, very, very important as clinicians and as lab professionals, as anybody that we I don't want to say, I hate to use the word mental health. It's it's like, no, but that we can not alter vulnerabilities and say, yeah, I'm really good as, as a dentist, but I may not be as good of a friend because, you know, I maybe forgot to call you when I was in the office till three in the morning, and I should have spent time and, you know, and I didn't. 00:30:00:04 - 00:30:18:08 Rob I, I traveled a lot for work. And I'm always in airports and so usually often alone and usually, you know, if I have a layover, whoever is at the airport bar next to me, there's my entertainment for the evening, you know, if they're open to have a conversation, you can almost always tell, like, hey, how are you? And then immediately, if they want to talk or not. 00:30:18:16 - 00:30:38:37 Rob I had had some kind of, fight with my then fiance, and it was, I had said I just didn't have time for that. And he says, that's not right. I said, what do you mean? He goes, don't ever say that again to yourself. Say it just wasn't a priority. Maybe it wasn't a priority. If you really are a friend, you know, you can kind of understand and relate to that. 00:30:38:37 - 00:30:42:59 Rob But like just being honest about it, you know, that wasn't a priority for me. 00:30:43:04 - 00:31:08:56 Adam Yeah. Well, that's to your point, to even taking it second even further than priority is that everything is a choice. Everything is a choice. What was not a choice was what happened to my brother. Right? That was not a choice. What happened after it, even though I could admit or not admit it was still a choice, right? So I look at those choices as when we have a failure or when something doesn't work out. 00:31:08:56 - 00:31:25:56 Adam Is data collection right? Even though my ego may hurt and I feel terrible for this human and I want a good outcome, we don't always get it. So if I look at it from, again, this whole experience with my brother was, you know, where am I living, lower or not, but data collection in terms of failures, like maybe I could learn something. 00:31:26:08 - 00:31:52:13 Adam Maybe. Maybe I can learn something, but maybe I don't know what. I don't even know. Let me just capture how I feel in the moment. Get back to it later, you know? So, you know, the point with that is that does the work dentistry connect me to my life or consume my life or both. Right. So these are the things that I love to talk about, that when I finally started to have a healthier understanding of this, I became a better clinician. 00:31:52:20 - 00:32:08:40 Adam I became much more discerning in the cases I will and won't take. I became much more. And that has nothing to do with money. And I say to people, if I don't know if I can, I say douchebag, you know? But if we have a no douchebag role, I don't care. If you want to pay me ten x on that case that I'm going to do it. 00:32:08:40 - 00:32:23:32 Adam If you're a douchebag, there's no place for you. In my practice, I don't care. Revenue is important, and I'm not going to say it doesn't. It pays the bills, it pays staff, it keeps the lights on. We got to be cognizant of that. But we all have to also understand. We have to know ourselves well and what is important is not. 00:32:23:40 - 00:32:51:37 Adam So it's been this paradox. And that's where I call like beautiful pain right. And connective tissue that basically evolves from scar tissue is that if you understand that scar tissue exists, you can understand and build connective tissue from it. And that beautiful pain is kind of that practice is better now, you know, because I've made the mistakes. I'm going to continue to make the mistakes, but I'm open to learning from them and not looking at it as a diagnosis of me as a character, as a person. 00:32:51:37 - 00:33:03:05 Adam It's just, no, this is an isolated incident, an isolated thing. And I'm going to draw upon the connections that dentistry has from some of the really smart people that I've, that I've spoken to along the way that helped me through it. 00:33:03:06 - 00:33:09:23 Rob So sounds like that's probably impacted the way that you interact with and empathize with patients as well. 00:33:09:37 - 00:33:36:08 Adam 100%, 100%, you know, so when they come in and this is actually something I, I, I actually wanted to share something. I took a note before basically what patients come in and they say I want an implant, I want teeth, I want, you know, I want to write whatever that they want. What they also are asking for is I want to live better. 00:33:36:18 - 00:33:50:04 Adam Why did they want to live better? It's not just that they're compressing it to the product. I want an important okay, why do you want an implant? So I tell my staff when when they call, I'm like, clearly you're calling for a reason. You want an implant. But what makes you feel like. Are you are you in pain? 00:33:50:08 - 00:34:20:42 Adam Are you having trouble chewing? Do you not smile? Is it affecting you psychologically? Because there is a reason that you see the need to do some due diligence, to invest some time dollars in my expertise as a clinician to give you an outcome. Right. So let's get to the core of what that is. So it's allowed me to really hear people stories and consult, not just compress it to the point and say, yeah, okay, let's treatment plan implant surgical guide abutment, immediate temp temp cylinder okay p f right. 00:34:20:47 - 00:34:42:23 Adam Custom custom CAD cam abutment, Emax crown angulated screw channel. Right. All of that kind of stuff. Right. But ultimately, like, patients are just like, I just like, I don't wanna think about my teeth. I want to live my life and I want to smile, be confident. And some people are so impaired. They're so wounded, you know? So my consults, I don't want to say, have shifted, but I literally sit before even talk about teeth. 00:34:42:25 - 00:34:59:47 Adam I'm like, let me meet the person. Let me understand why you're here. And they say, you know, it's a story my grandparents or my my grandchild, she won't look at me because she's afraid that I look like a jackal. Whatever it is, that's devastating. So I said, like, if you're my mother, if you're someone I love, I love my mother, by the way. 00:34:59:49 - 00:35:15:04 Adam But if you're someone I love, what would I want for you? And I want to understand how this is impacting you. And then what would Dunn look like? Another question. What would Dunn look like? I don't want to hear implants. I don't want to hear, you know, you know, harvest pork. You know, I don't want to hear material. 00:35:15:06 - 00:35:31:01 Adam What does that look like for you? It typically is like, I want to go out in a meal and really enjoy time with my spouse or my best friend and, like, have a steak or corn on the cob. I want to smile for pictures and not be embarrassed and talk with my lips like this the whole time because I'm so guarded and I won't open up. 00:35:31:08 - 00:35:47:20 Adam So that's so telling. That first five minutes to the console. And then I say to them, okay, I don't really know what we're going to do, but I also now I understand what success looks like. It does two things. One, it allows me to understand, but two, it allows them to feel like they're heard that that that being heard builds trust. 00:35:47:20 - 00:36:05:28 Adam That trust is an annuity. And what a patient's choosing, it's not choosing materials. It's choosing a person and an office and a vibe. It's not my implant. It's you're buying my judgment. So ultimately, when they buy my judgment, trust and vibe, that's what I try to get. Not that I'm selling that I'm sensing. Also, are they good for me and am I good for them? 00:36:05:40 - 00:36:24:25 Adam Right? I love to tell them I'm deemed not God. I'm not God, right. There is a firm limitation from what I'm capable of. And then biology is going to do what biology is going to do. Material science is going to do what material science is going to do. The cycling of every chew that you take and the way your bone responses to it, that's going to do what it's going to do. 00:36:24:25 - 00:36:43:28 Adam And then there's your brain that even the best prosthetic under the sun, the contours of that are not your teeth. Right. So how are we going to, you know, so I, I have those conversations with people. So once I understand what success looks like, we'll then say these are the clinical records that we need to take. And then I leave them feeling I don't necessarily say, here's the plan for you. 00:36:43:30 - 00:36:59:42 Adam Because if it's a complex care case, I need to think about it. But I'll say is, listen, a, I can help you be I want you to leave with hope. Right. See, you know, I need to spend more time to like an architect puts a blueprint together diagnostically, come up with different paths. And the. If the ends of. 00:36:59:47 - 00:37:18:28 Adam What about contingency. Right. So that's where knowing myself has created really healthy boundaries for that, you know, psychological safety in my office and my team in me. And we don't always we do develop God complex because a lot of the times what we do do really does impact people. It changes their lives so profoundly. Right. How many times you get a picture from someone? 00:37:18:28 - 00:37:44:16 Adam And I always said, Mike and guys that evolution, I'm like, listen, look at what you did to change this person's life. I want you to know that your work has a freaking impact. You know, that's so important. You know, and and it means it means something. But when the patients put that onus on us as clinicians and as folks in the lab, there's there's a subconscious boundary that they may cross that we're not necessarily trained to handle. 00:37:44:28 - 00:37:47:37 Adam So I've been learning more about that as well. 00:37:47:42 - 00:37:52:13 Rob Sounds like it's made the the work a lot more rewarding than it already was, even. 00:37:52:18 - 00:37:53:30 Adam In challenging. 00:37:53:35 - 00:37:55:25 Rob And challenging. Yeah. 00:37:55:30 - 00:38:17:37 Adam Because these are you know, these are these honestly, I am not afraid to have difficult conversations. I actually love them. I don't mind them, but it makes very people very uncomfortable at times, makes them very awkward. The things that I not that I say, but like the questions I'll ask, or even the things that I'll go there with people that somebody may come in hot and aggressive and like really, really mean. 00:38:17:42 - 00:38:32:28 Adam And I'll say to them, you know, like straight up like, I don't take it, I don't, I don't take it personally because it's not me, it's them. And I don't say, it's not me, it's you. But I'll say it. I'm like, I said, I'll say it. I'm like, listen, we just met for five minutes. I said, I'm a really nice guy. 00:38:32:32 - 00:38:50:23 Adam My staff is really nice, the really respectful. We have a big rule of respect here. So we this can go on. And two ways I know I didn't do anything to trigger at least if I did tell me so if I did, please. But if I didn't tell me what's causing this, tell me why it is. Is it was it a past dental experience? 00:38:50:28 - 00:39:03:58 Adam Did you have a sick relative at home? Did you have. You know, I'm not saying you have a sick relative, but is there something that's going on right now? And it's being projected into this conversation? Because if that's the way we're going to communicate, we're not going to be able to a professional relationship. Like I'll straight up say that to me. 00:39:04:01 - 00:39:19:13 Adam And 1 or 2 things will happen. One of the be like, you know, I'm so sorry. My, my spouse is, is, I don't know, going through chemo right now and it's just too much and, you know, and I'm like, oh, I'm so sorry to hear that. And I said, you know, let's let's, you know, tell me about your spouse. 00:39:19:13 - 00:39:36:06 Adam Tell me what's going on. Right. And I said, you know, and then obviously to balance this dentistry, I said, well, if your spouse is going through chemo, right, maybe this is not the best time, but if there's something we can do to get you more comfortable to the point where you're emotionally ready, that then builds that report on the other side, they could just continue to be it. 00:39:36:11 - 00:40:02:18 Adam And I'm just like, all right, you know what? If that's who you are and you got to prove stuff to people, this is just not how we operate here. And that's fine. There's going to be someone trials for you out there. But I'm not that guy. And that's cool too, right? I don't care, you know? But it's like at that point, you know, I don't I don't need to chase after units until after arches for the sake of like more, more, more notches in a belt so I can put it on Instagram and feel awesome. 00:40:02:23 - 00:40:04:13 Adam Well, you know, just don't. 00:40:04:13 - 00:40:07:20 Rob Yeah, yeah. What what what good is that in the grand scheme? 00:40:07:25 - 00:40:08:20 Adam No. 00:40:08:25 - 00:40:32:01 Rob And what you're saying kind of reminds me of a, what I, I listened to it like a documentary a couple of years ago about the way Chinese medicine used to be practiced. And a lot of it's the whole feng shui approach. And it sounds really on the level at first. But when you start to realize that there they in this this used to be a thing with regular with regular doctors is they would make house calls. 00:40:32:06 - 00:40:57:20 Rob And more often than not, it wasn't a treatment for an actual disease that they had to, had to facilitate. It was going to the house and seeing, well, how do these people live? Maybe there's something about the way they're living, about their greater background, about who they are. That's actually the cause. And we're just seeing the symptoms and your point, like you're maybe if your husband is going through chemo, maybe this isn't the time to do the whole all on expert. 00:40:57:20 - 00:40:57:59 Rob Dr.. 00:40:58:04 - 00:41:15:37 Adam Yes. And then, you know, it's interesting like these are the questions. It's like, you know, you know, my functioning and doing. Yes. These people, my functioning doing well. And who knows how I'm actually doing under the surface. Like, you know, we just see what we choose to present to the world. We don't see what's going on underneath all that, all that thing. 00:41:15:37 - 00:41:39:11 Adam And that's that's who we are. That's who you are. That's who I am. You know, it's that we don't see that. So, you know, with these folks are so much more going on than just I need teeth. Right. And I'm not trying to do a psychoanalysis to them, but it's really important. And we have to understand that for selves, am I functioning or am I actually doing well, or do I perceive like I'm functioning well but actually crying on the inside? 00:41:39:11 - 00:42:12:11 Adam And that's that's just for us, for our patients too. Right. So understanding that and to to your point, how people are living, it does have an impact. And those people even you look at there's there's a lot of science high cortisol, the neuroscience behind it, the stress that that may not be a good fit right now for what they're asking and looking at, not just the mouth and the pan and the CBC and the diagnostic diagnostics, but looking at the person two on intake, especially on high stakes dentistry, like a really high stakes dentistry, which is about is still important utilitarian dentistry. 00:42:12:11 - 00:42:33:23 Adam I need a crowd. Not a big deal. I think it's not a big deal, but it's transactional. One time done, one and done, you know, cleaning one and done right. But multi-step, involved. Relational dentistry needs a greater understanding of the self. As a dentist, the team there needs to be alignment with the lab. There needs to be alignment with the patient and knowing when to hold them and when to fold them.. 00:42:33:28 - 00:42:43:45 Rob In addition to what you just shared. What would be something as somebody who sits on the board, the exam board, what would be something that you wish you could impart on every doctor stepping into implants? 00:42:43:49 - 00:43:13:21 Adam So I am so I'm involved with the American Board of Oral implants, and I'm a board examiner as well. I'm actually the incoming president. And one of the cool things about, you know, any board is anything educational. It's that one of the things that we assess on this exam. So in order to become a board, become a diplomat, there's a there's a process, a you have to complete some hours of education, go through either a postgraduate program and there's alternate routes. 00:43:13:25 - 00:43:47:11 Adam But then you have to take a written test that's memorization. And then there is a oral exam which you have to submit eight cases, you know, from over dentures, singles, sinus lifts, soft tissue, hard tissue, full arch, you know, all different scenarios. And I'm not necessarily interested of you being able to complete cases. This is a beautiful exam because it's an oral exam where we assess thinking, if I would give anybody the advice as a candidate or anybody, whether they want to be a candidate or not, the most important tool that we have is not technology. 00:43:47:25 - 00:44:16:40 Adam It's the thinking and the critical thinking about these cases. How do we critically think I'm interested in assessing the mindset that m I, as an examiner, examining your ability to keep the public safe, to keep this patient safe, because this patient's a mother, a father, a son, a brother, this. And if you or me or on the operating room table with this person and shit happens because that's the story of my life, how do we course correct to keep this person safe? 00:44:16:45 - 00:44:44:42 Adam Okay. And and exercise judgment to not make it about us, about revenue, but more so what's the best for that person? So it's that thinking. What were you thinking? Take us through the steps. Okay. And this is one of the things I love to do as a board examiner. I'm like, okay, let's say you do this on this great guided case and you have the case flat and you're about to do a conversion, and then your system runs over and the the guide shatters into a million pieces in the case it's flat and the person's intubated. 00:44:44:45 - 00:45:16:06 Adam You know, what do you do? Right. So. Well, I don't know. The lab told me to do that. That's not a good answer, you know. Well, how do you set up a case with, like, a Chrome situation? Right. Well, the lab does it, I don't know. I want you to understand the rationale that the lab has taken and why they put them into the scheme and why you're doing, a hexed versus a conical, why you're doing a 30 degree, you know, versus a, you know, 15 degree, you know, like a 17 degree why you would choose this or you want this type of screw versus that, not because, you know, Mike Pecos is using 00:45:16:06 - 00:45:53:13 Adam it or this one's using it or, you know, or Rob's using it. No, because it has this geometry. It'll affect because this patient really needs a lot of shear protection. We're over. You know, it's that thinking that allows us to really become difference between somebody that just took a, you know, paint by numbers weekend course. Right. You know, that's step one, step two, step three, as opposed to a real deep clinician thinker implant the best lab technicians that I've ever worked with, the most brilliant minds that really understand how to troubleshoot forces and things that I can't even begin. 00:45:53:21 - 00:46:04:23 Adam So that's where I loved working with Andy. That's where I love I, so I don't choose to work with labs. I work with technicians, brilliant minds that can help me see blind spots and help me think through it. So I know that's a long answer, but like. 00:46:04:30 - 00:46:05:42 Rob That's a great answer. 00:46:05:47 - 00:46:24:42 Adam And that that's also what's going to help us in the age of AI. I don't believe AI is going to eliminate jobs. It's going to do it. You know, what it's going to do is going to have to make us more intentional thinkers, being able to understand what we want, what the output may be. And if we don't understand the output, what questions need to be asked to create more clarity. 00:46:24:47 - 00:46:28:11 Rob So that was beautiful. Thank you so much for doing this. 00:46:28:13 - 00:46:28:54 Adam This is awesome. 00:46:29:06 - 00:46:39:01 Rob A pleasure. I could do this all day. Where where can people find you online to learn from you? Catch your lectures. Where are you on social media? Where can people find you? 00:46:39:06 - 00:46:58:19 Adam So I have I do have social media accounts. I haven't checked them in three years. I have a speaker website called Adam Scott. Com. It's not very fancy. I just put it together, but, I'm looking to speak more about this stuff, so. Adam Kim. Com I practice in Denville, new Jersey. My practice, I can't. Sorry, Siri. 00:46:58:33 - 00:47:05:40 Adam My my practice is, dental dentist. Com very active in the Academy of American Academy, a boy. 00:47:05:45 - 00:47:07:25 Rob Thank you again for being a part of this. 00:47:07:35 - 00:47:09:46 Adam Yeah. Thank you to brother. This is awesome. 00:47:09:51 - 00:47:31:13 Rob This is great. Great. And thank you, everyone else, for joining us for this episode of the Evolution of Dental Podcast. Please look for us on all the major podcast platforms and all the social media platforms as the Evolution of Dental Podcast. Please remember to like, subscribe, share, comment if something in this episode really struck a chord with you, I'm really curious what what stood out to you as our listeners? 00:47:31:18 - 00:47:39:54 Rob And please visit the website for any kind of sign ups you want to do for CAD courses. And remember, never stop evolving.