Zygomatic Implants, Guided Surgery & Digital Technology | Dr. Dan Holtzclaw | EODP #46

00:00:00:10 - 00:00:21:52 Speaker 1 All this stuff that's now just considered basic knowledge. Oh, yeah, everybody knows that. You know, at one time, it wasn't basic knowledge. You know, we didn't know that. And people had to actually do the research to establish those characters, you know. But if you're reading the lit, if you know, you know, the historical articles, you're going to know all these names. 00:00:21:54 - 00:00:47:34 Speaker 1 And, you know, for me, you know, those are the people that I always considered. You know, to me, the goats and people kind of whisper about you. They're like, oh, that's the guy that you know. Does, you know, that all on X stuff, you know, and all in X, that wasn't even, you know, a word back then. It was, you know, it was all on for. 00:00:47:39 - 00:01:07:37 Speaker 2 Welcome back to the Evolution of Dental Podcast. Brought to you by Evolution Dental Science. We share the stories of the people and the technology shaping the world of dentistry. I'm your host, Rob Norton. And today's guest. Well, most surgeons look at upper jaws with no bone, and they just send it out with or on to somebody else to deal with. 00:01:07:42 - 00:01:24:42 Speaker 2 My guest today built his career on the opposite answer. He learned precision by taking care of pilots who fly 18in apart. He literally wrote the book on anchoring teeth into the shark bone. Doctor Dan Holtzclaw. Welcome to the Evolution of Dental podcast. How are you today, Sam? 00:01:24:44 - 00:01:26:49 Speaker 1 Great. Thanks for having me on. How are you? 00:01:26:54 - 00:01:51:01 Speaker 2 Thanks for being here. I'm doing great. And before we always, we hit some of the coolest parts. Right before we hit record, you were telling us about an experience you had recently getting on an airplane and listening to clips of a couple of podcasts there. And you say that's not normally what you come up with, but you were hearing these guys talk about what you thought were what they thought were the goats of implant dentistry, and they weren't people you've heard of before. 00:01:51:06 - 00:01:54:51 Speaker 2 Who do you think of the goats of the implant industry? 00:01:54:56 - 00:02:15:27 Speaker 1 Well, thanks. You know, little context on that conversation. So, you know, I fly a lot. I travel on the road. I think last year I was on 300 nights on the road. And this year, probably about 250 nights. I'll be on the road. It's a typically my, you know, my, my pattern is I get on an airplane, but my headphones on. 00:02:15:27 - 00:02:39:32 Speaker 1 So I talk to anybody. And, you know, I'm usually either just watch movie or doing, you know, some research or something. And I was scrolling through Instagram and had these little clip it, you know, little snippets of a show come on. And it was some younger guys and they're talking about, you know, the goats of implant dentistry. And so I, you know, I click it and I'm listening to it. 00:02:39:37 - 00:03:08:42 Speaker 1 And it's funny because I never heard of anybody that they're talking about, you know, and a lot of the doctors they were talking about were, you know, relatively young. And I'm just like, I've never heard of any of these people. And, you know, I'm thinking I was like, okay, well where is where's the discussion of, you know, Link and Carl Mesh and, you know, like Pecos Marie Salama and Dennis Tano, you know, who? 00:03:08:44 - 00:03:32:22 Speaker 1 I guess, to me, I would consider those in terms of, you know, a lot of the things that we take for granted now of common knowledge, you know, for example, how how close can you put implants together and still have a papilla, you know, do you need, you know, can you immediately load them? You know, what talk do you need all this stuff that's now just considered basic knowledge? 00:03:32:25 - 00:03:53:10 Speaker 1 Oh yeah. Everybody knows that. You know, at one time it wasn't basic knowledge. You know, we didn't know that. And people had to actually do the research to establish those parameters. You know, I felt really fortunate because, you know, some of those doctors, I'm, you know, good friends with now and, you know, some doctors are more approachable than others. 00:03:53:13 - 00:04:16:44 Speaker 1 You know, there's some other doctors that, you know, to me, you know, I was very, you know, in a very respectful of and you might see them somewhere and that a meeting or maybe even in an airport or something. And, you know, I remember some I, you know, I'd see them and I say, oh my gosh, you know, it's doctor So-and-so and I'd, you know, go try to introduce myself and say hi. 00:04:16:46 - 00:04:35:51 Speaker 1 And I remember there was one particular one. I mean, he looked at me like I must have been a stray dog or something. He just didn't say hi. Nothing. Just kind of like gave me this look and was just like, you know, get away from me. Didn't. And they just kept walking. Didn't even say anything, you know? And then, you know, for example. 00:04:35:56 - 00:05:00:01 Speaker 1 Mike Pecos, you know, like, you know, I love Mike because, you know, the first time I met him, I remember I'm walking through Caesar's Palace, and I was at a meeting and with my wife, and I see, you know, Doctor Pecos sitting in a noodle shop all by himself eating some noodles. And I told my wife, I said, oh, my gosh, I said, that's that's Doctor Pecos. 00:05:00:13 - 00:05:19:00 Speaker 1 And I said, you know, I said, I'm going to go say hi. And so, you know, I walk in and I just introduce myself and tell him, you know, a big fan of his work and, you know, preciate all he's done for the industry. And, and, you know, he is nice. He says, hey, you know, thank you. Would, would you want to sit down for a second? 00:05:19:01 - 00:05:33:54 Speaker 1 So I was like, oh yeah. So I sit down and have a nice little chat. But Pecos for a minute, you know, introduce my wife and you know, he took time to say hi and talk to me and, you know, and then I said, you know, I want to be respectful of his time. Don't want to interrupt his noodles. 00:05:33:58 - 00:05:52:13 Speaker 1 So I said, you know, thanks for talking with me. And, you know, and I leave him and, you know, that was great. And you remember that, you know, 25 years later, I'm still really good friends with him. And then, you know, I bring up some of those names and, you know, they don't even know some of them anymore and was like, wow, one. 00:05:52:15 - 00:06:15:39 Speaker 1 You know, that's just kind of sad because one that tells me they don't read the lit because if they read the lit, they know these names. You know, it's just because it's not posted on Instagram, you know, and spoon fed to people anymore, you know? But if you're reading the lit, if you know, you know the historical articles which you should know the classic lit, you're going to know all these names. 00:06:15:39 - 00:06:32:32 Speaker 1 And, you know, for me, you know, those are the people that I always considered. You know, to me, the goats and the people that, you know, really laid the foundation as to where we are now. 00:06:32:37 - 00:06:51:10 Speaker 2 That that makes a lot of sense. And, it is it does seem like, especially in the world of the way that we consume media now, that a lot of things get washed away like that and that some of the baseline, that that foundation you're talking about just kind of gets glossed over. Which, I mean, you come from a Navy background. 00:06:51:10 - 00:07:10:08 Speaker 2 Is that. That's right. I mean, I see your hat. So it's kind of the opposite world over there where it's like your foundations are the foundation. How how did that, how did that influence how you how you entered into dentistry? Because you started Império before you went into zygote. Like, that's a that's a big jump there in and of itself. 00:07:10:13 - 00:07:46:46 Speaker 1 Yeah. Well, and before that I was a gentle dentist, you know, so I, I joined a Navy because one I needed money for school, you know, I didn't come from background of of money, you know, I, I needed money to go to school. And so I joined the Navy and, you know, it was luckily enough to get a scholarship and, you know, the those foundational, teachings, you know, you carry with you and, you know, discipline and work that thick and, you know, living. 00:07:46:51 - 00:08:10:49 Speaker 1 I just say, you know, like on a fairly meager means, you know, because when you're in the military, you're not getting paid very much. When I had left the Navy, I was in for 13 years. I was a specialist at that time. And, you know, my tax return was still dramatically less than what somebody first year at a dental school is getting. 00:08:10:54 - 00:08:40:32 Speaker 1 But, you know, those years in, you know, one, I was serving my country. So I was very happy and proud about that. And then two, I got a lot of good training. You know, I got I did a PR, in, in my first in the Navy, I did general dentistry for a few years, and then I did period training, and then I got to live in some great places that I would have never, you know, got to live in if I had been in the civilian world. 00:08:40:34 - 00:08:59:06 Speaker 1 You know, I was always by a beach. I got to live in Hawaii for three years. You know, I got to get periodontist for the Blue Angels, so I got to, you know, see them fly over the clinic. You know, it's just amazing. If you've never seen them fly, it's definitely something to behold. I don't care if you've seen them even a hundred times or a thousand times. 00:08:59:06 - 00:09:24:51 Speaker 1 Anytime you see the jets flying over like that, you stop what you're doing and you watch. So all those experience, you know, we're great. And you know, even from my family, like, you know, with with with my children just growing up in that military environment and the worth ethic, you know, now they're grown and I can see how it's, you know, translated, to them and impacted their lives. 00:09:24:51 - 00:09:44:06 Speaker 1 And so, you know, it's not all just about money and how much you're getting paid, you know, it's how it affects you and, and, shapes the, the person that you are and your and your family because, you know, it ends up rubbing off on your family that way. And so, yeah, I was very happy about that time. 00:09:44:08 - 00:10:06:44 Speaker 1 And, you know, that I had in the military and, you know, even now it's still follows you because you know, everything you do and you know how discipline you are. You know what, what time you wake up, you know, are you going to exercise? You know, the how you eat all that type of stuff. You know, you develop a lot of that discipline, you know, while you're in the military. 00:10:06:49 - 00:10:16:44 Speaker 2 What does the where's the periodontist do with the Blue Angels? Exactly. Like how how much was how much was that work involved? Like, I'm trying to think you're I'm trying to picture how this comes together. 00:10:16:49 - 00:10:45:54 Speaker 1 You basically are covering an area. So for example, I don't even think that that billet exists anymore. But when I was a periodontist there, I was responsible for doing all the, you know, period specialty care from basically for the Gulf Coast of the United States. So from Pensacola all the way to New Orleans. So if you were, you know, Navy, Coast Guard, Marines, even if you were in other branches, if you needed work, you would go to Pensacola. 00:10:45:58 - 00:11:01:44 Speaker 1 And so, you know, we're taking care of, you know, all of the, you know, the the Blue Angels, but really wasn't the pilot. So we're taking care of because, you know, they're all the Blue Angels held a really, really high standards. And so most of them don't have any paranormal disease or had missing teeth. 00:11:01:44 - 00:11:04:44 Speaker 2 Or that's kind of what I was wondering, because it's like as like, how does that work together? 00:11:04:46 - 00:11:26:18 Speaker 1 But you're taking care of you're taking care of the crew. You know, all the mechanics you take care of, you know, all the behind the scenes thing. So, you know, there's you got the eight pilots on the team, but then you've got this entire giant support staff behind them that you don't know. And then they also do, you know, flight training on that base. 00:11:26:22 - 00:11:49:18 Speaker 1 You've got other air squads from other countries there. So for example, you know, we took care of there was a German air wing out there and he take care of them. And then you take care of, you know, all the people on the base period that you didn't have anything to do with the Blue Angels or anything. You know, the people that work at the medical clinic, the people that worked, you know, in the other parts of the base. 00:11:49:22 - 00:12:01:08 Speaker 1 And, you know, so you were there in the period for the blue end, but you were also taking care of, you know, a lot of other people. 00:12:01:13 - 00:12:18:46 Speaker 2 Oh, I didn't see you there. Hey, y'all, it's Robert with the Evolution of Dental podcast. If you love these stories and you want to see more guests, more content and help the show, please remember to share it. Like it? Subscribe to our channel and hit that little notification bell if you're watching on YouTube so you can get notified of our new episodes. 00:12:18:54 - 00:12:35:34 Speaker 2 New episodes drop every Friday. Follow us on all the socials. You'll see all the latest content. Looking forward to seeing you there. Most perils don't jump from period to implant, not least not the ones I've met. So that's that's in and of itself, a pretty unique story. It's got to be. 00:12:35:39 - 00:12:58:56 Speaker 1 Well, that so that was a roundabout way of getting there because you're right. Most I mean, most periodontist will do implants and you're talking about conventional implants, single unit multiple implants, all ex. But then when you're starting to get to the remote Anchorage, you know, the funny thing is, not long ago there weren't a whole lot of people, period, doing remote Anchorage. 00:12:59:08 - 00:13:22:15 Speaker 1 I mean, if you go back in time ten years, even most oral surgeons weren't doing remote Anchorage. You know, there was a handful and that was it. And, you know, so there's been a this huge shift in the last ten years. And so the way I got there was when I left the military, I purchased a periodontal practice. 00:13:22:25 - 00:13:51:32 Speaker 1 I was doing traditional. And the part I actually grew my practice the fastest on was guided tissue regeneration. I was actually really good at growing bone and little tiny defects between teeth, which is somewhat difficult to do. And you know, the way I was doing it, I was getting really good results. And so I started getting all these referrals from doctors in town for that. 00:13:51:39 - 00:14:13:20 Speaker 1 And, you know, so grew the business. And, you know, I still liked implants, I always liked implants. And I was doing arches. And I had done some of my first arches back in the Navy. But when I got out, you know, I was doing them, you know, in private practice. And back at that time, it was not commonplace. 00:14:13:25 - 00:14:42:42 Speaker 1 You know, there used to be a saying that was all on four, none on three, and you don't hear that anymore. But you used to hear it all the time. And it was if you did full arch dentistry, you know, all in dentistry, you know, you were looked at as a pariah. You know, you'd walk in. I remember walking into rooms at meetings and, you know, people kind of whisper about you and they're like, oh, that's the guy that, you know, does, you know that all on X stuff, you know, and all in X, that wasn't even, you know, a word back then. 00:14:42:42 - 00:14:44:08 Speaker 1 It was, you know, it was all on four. 00:14:44:15 - 00:14:44:58 Speaker 2 Oh, I'm four. 00:14:45:03 - 00:15:05:15 Speaker 1 And you know, at that time there was maybe there's maybe three of us in town that did a lot of them and that's it. And, you know, now it's, you know, everyone in their grandma does all in X, and but at that time it wasn't. And so I was doing a lot of them and I, I really liked it. 00:15:05:18 - 00:15:30:37 Speaker 1 And I said, you know what? I want to do more of a focus on this. And so, you know, I, I sold my practice and then decided I went to open, you know, an implant center, more of, you know, like a, you know, clear choices, really the pioneer of, you know, commercial full arch implant dentistry. And so I said, you know, I'd like to have something like a clear choice. 00:15:30:42 - 00:15:53:58 Speaker 1 And so, you know, so I was doing so I was doing all in X. And eventually, as time goes on, if you look at all the research on all on X, you know that as time goes on, you're going to have failures and you're going to have bone loss. And especially back at that time, because we didn't know all the tips and tricks and things that we know now. 00:15:54:03 - 00:16:08:49 Speaker 1 You know, I had sold my practice years ago. And so a lot of my patients now are spread to the wind getting maintenance at other offices. So I'll see, you know, because I got of cases out there, I'll see some of them pop up on Facebook groups of like, you know, I had this patient come in for maintenance. 00:16:08:49 - 00:16:28:01 Speaker 1 Does anyone know what these implants are? And, you know, sometimes you see these old cases and, you know, you do what you know at the time and what you know, at that time. You know, again, my skills were different back then that just, you know, criticize the work on these old cases. And you're just like, man, it's like it was different back then. 00:16:28:03 - 00:16:53:08 Speaker 1 You didn't know all these things. And hey, even though it's not beautiful and perfect, it's still holding up ten, 15 years later. You know, nobody mentions the criticize these little things. And so as my practice got older, I started having some cases that would had failures. And so the most common implant that would fail is the angulated implant in the maxilla, right. 00:16:53:10 - 00:17:10:15 Speaker 1 The the most posterior implant before the sinus because the bone is it's soft there. And so and you have cantilever attached to it. And so you know, if that failed is really a pain because you'd have to do a sinus graft, you'd have to cut the restoration, you have to let that he'll then you come back, put the implants in, let that heal. 00:17:10:20 - 00:17:27:42 Speaker 1 And then you could fix everything. So, you know, it's a long process. And so, you know, I had a handful of those. And I just like, there's got to be a better way to do this. And I had heard about pterygoid implants and I remember where I had heard about them. But I was like, you know, it was very mysterious. 00:17:27:44 - 00:17:51:30 Speaker 1 Like nobody knew what they were like. Like no one even heard of them. And I remember there was one doctor out in Luxembourg on Read Diedrich, and I knew he did some. So I started chatting with him and then I did some online. I did some lit pull, you know, I pulled a bunch of literature on anatomy. I pulled a bunch of literature on, like, foret surgery. 00:17:51:34 - 00:18:09:39 Speaker 1 You know, what I could find on pterygoid implants? Reddit. And, you know, there's no instruction, there's no courses, there's no books, no videos. So I just said, okay, I'm going to give this a shot. You know, I read all these articles, I read all the new me. It's like, I, I think this is how you do it. 00:18:09:44 - 00:18:27:18 Speaker 1 So I'm going to give it a try. So I did. And luckily, you know, all first cases turned out well. Now I can tell you I was scared to death. I mean, I was literally scared to death on these because, you know, you read about the anatomy in the pterygoid area, and there's a lot of dangerous anatomy back there. 00:18:27:22 - 00:18:49:10 Speaker 1 And, you know, I remember just like, literally sweating. And fortunately, those first cases turned out well. And then you started doing more and more and you were finding the technique. And then I got to the point of onset of just using these to salvage cases. You know, I could use them for all my cases because I can eliminate the cantilever. 00:18:49:15 - 00:19:11:44 Speaker 1 And so and I find I could do it pretty predictably. I'm getting good talk. You know, I'm, I'm hitting it most of the time. So I started incorporating it into all my cases and, you know, and I would place the pterygoid implant first, and then I'd move on to my other implants in the arch, usually do the front implant. 00:19:11:51 - 00:19:33:58 Speaker 1 And then I had one in the back, one in the front. I kind of split difference in the middle. So I'd been doing that for years, you know, and eventually over time, you know, we didn't call it anything. But eventually, over time, that ends up becoming the patsy protocol, you know, which is now very common knowledge. Now, but in back then, we didn't call it anything. 00:19:33:58 - 00:19:57:37 Speaker 1 It was just we always placed the pterygoid implants first. But I placed the terror boards because I needed them to save my own cases. And then zygotes came into play because we were getting a lot of patients come in that usually they didn't have any bone. And you know, before knowing how to do zygotes, I would do giant sinus lists. 00:19:57:42 - 00:20:21:40 Speaker 1 And, you know, again, talking about goats of implant dentistry, you know, like another one I would say is, you know, mesure and stuff from so you go back to talk about sinus grafting, you know, like those are two of the goats of sinus grafting. And so I learned my sinus grafting from Ziv and you know, doctor from and you know, so I could grow a ton of bone in the scientists. 00:20:21:40 - 00:20:48:32 Speaker 1 And so that's what I used to do. I would do these big giant sinus graphs, let it heal, and then I come back and put implants in. And then you even if you grow this great bone in the sinus, it's usually kind of soft still and using it for remote Anchorage, especially on a when you're using it for Anchorage on a really atrophic ridge, you know, asking that to hold up for a long, long period of time is asking you to do a lot. 00:20:48:37 - 00:21:19:15 Speaker 1 And so on. Some of these cases, I said, you know, we're going to need to, you know, bite the bullet and do zygotes. And so, went and took a one day zygomatic implant course with a doctor who was, I had a, a, an oral surgeon that was working in my office as a contractor. I had actually purchased his office years before, and he was working for me as a contractor. 00:21:19:15 - 00:21:39:28 Speaker 1 And we literally went to a one day zygote course together. Neither of us had done zygotes before, and we took this one day course on models. And that was the extent of our dogmatic implant training. Was this little one day course. And again. 00:21:39:33 - 00:21:59:44 Speaker 1 That that part has even come a long way, because back then it really wasn't any systematic teaching. It was literally here, watch me do one. You do one on these models and that's it. That was the extent of the training. You watched this guy do a surgery on this camera, and you can see like half of what you needed to see. 00:21:59:49 - 00:22:20:42 Speaker 1 There really wasn't any step by step instructions. It was just like, okay, watch me do it. Okay. Now you do it on this model and you guys go do it. And that was it. And, you know, I could tell you the first time I did as I go, I got no to work, you know. So at one time, my zygomatic implant success rate was zero because, you know, at place one, I think getting to work. 00:22:20:44 - 00:22:45:37 Speaker 1 And so I had 0% success at one time. So I felt I felt terrible. I put that first one in just like God. Like it didn't work. Yeah. You know, because I had, you know, nobody did give me any structure or guidance or anything. And, you know, so now I feel that with where we are in teaching, you know, we've made it a very systematic step by step process. 00:22:45:42 - 00:23:07:32 Speaker 1 And so, you know, that's how I got there. You know, again, there's a there's a lot of trial and error in taking leap of faith and doing, you know, relying on the knowledge that you gained from reading articles and literature. And, you know, now, fortunately, we got some, you know, textbooks out there that make it a little step by step simple. 00:23:07:32 - 00:23:29:08 Speaker 1 And there's the social media. And, you know, a lot of is bad as social media is on a lot of things. It does have its good points. I mean, there's a lot of really good teaching that happens on social media. And, you know, whether it's good or bad, it's the reality of things now is a lot of people learn what they do just by watching social media videos. 00:23:29:13 - 00:23:55:18 Speaker 1 You know, which testament to how good some of these videos are, that you can watch it and learn and have a relative idea of how to do this, but, you know, that just didn't exist. And, and so, you know, again, shares some of my envy for the current generation of how much access they have to all this knowledge that's out there that we just didn't have at one time. 00:23:55:22 - 00:24:23:32 Speaker 2 You may think you're an excellent expert, but there is always more to learn. New features, new techniques, new updates all the time. If you'd like to get the most out of your investment, schedule an appointment with me. It's free. XO asked me, Robert, what are some of the things that you include in your in your protocols there that you teach that is that regimented way to look at this as opposed to just like you said, 30 degrees back and you're fine. 00:24:23:37 - 00:24:46:20 Speaker 1 Well, you know, one I teach, I've been really fortunate that, you know, I've been working with the same company now for going on nine years now. So I teach most of my courses through Norris Medical. You know, shameless plug with my coffee cup here. When we teach the courses through Norris, it's a very, again, systematic protocol. 00:24:46:27 - 00:25:11:44 Speaker 1 And, you know, we also teach things in a very logical fashion where many courses I'll see, they just kind of jump around and there's no organization. And it's just, you know, they may just jump in and start showing cases. And, you know, the the course has been curated over years because it's very different than when we first started teaching it. 00:25:11:49 - 00:25:31:06 Speaker 1 And, you know, it's evolved and change to be a very logical process. And step by step, you know, I'll teach, you know, we'll teach the anatomy on it because you got to have the anatomy foundation first. And then we'll teach, you know, the, the step by step how to use the anatomy to help guide you on the steps. 00:25:31:10 - 00:25:53:58 Speaker 1 And then we'll talk about the complications, because the best way to deal with complication is to one not have it. And by going through all these steps, checks and balances, you can really avoid many of these complications. And, you know, I'll tell you, I get asked to be an expert witness in many lawsuits. And, you know, I only work for the defense. 00:25:54:01 - 00:26:18:08 Speaker 1 You know, I only defend the doctors, you know, which unfortunately, you know, I know some of our colleagues, they literally, you know, one in particular relishes the opportunity to go after dentists. You know, it's, you know, they they literally like, oh, you know, I'm going to go after this dentist because they're doing something wrong. And you know, I think one has to prove you know how right they are. 00:26:18:13 - 00:26:39:34 Speaker 1 But, you know, I only defend the dentist and you know, a lot of them. I'll look at the case and say, hey, man, I really can't defend what you did here. I recommend you just settle. But if there is ways to defend it, you know, we'll defend it. But a lot of the errors that I see are all very preventable. 00:26:39:39 - 00:27:03:13 Speaker 1 You know, if, if they would have, you know, used this check and balance or this, you know, redundancy to double check themselves like that would have never happened in I mean, some of the errors you see are just really very basic, you know, like taking in a Cat scan at the end of the procedure and you could see, oh, my implants overextended, seven millimeters. 00:27:03:18 - 00:27:20:34 Speaker 1 You know, they didn't take a Cat scan at the end of the procedure, so they didn't see it as overextended seven millimeters or when they put the implant in, you know, especially, like on as I go, you check the apex, you know, you run an instrument over the end of the zygote. And, you know, if you're overextended, you're going to feel it. 00:27:20:39 - 00:27:46:13 Speaker 1 But if you didn't do that, you're not going to feel it. Then two we're you start having that issue is because also the way it's being taught. So for example, there's courses now teaching, you know, less invasive flats don't raise a big flap. And that just causes all kinds of problems. So if you're not raising big flaps where you could see the zygomatic, you know, one, you can't cool it when you're drilling. 00:27:46:18 - 00:28:01:06 Speaker 1 I mean, how are you going to cool the bone if the saline can't reach the bone? It's all covered up with tissue. Two, you can't see where you're going. Some of these courses are literally teaching. Put your finger here and just feel and drill to you. Hit your finger. 00:28:01:10 - 00:28:05:20 Speaker 2 And that doesn't sound like precision to me. No. 00:28:05:25 - 00:28:26:03 Speaker 1 So I mean so one you can't see where you're going to. You can't cool the bone. Three when you do drill through the bone, you create a lot of bone debris. That bone debris gets all trapped up under the flap. So if you don't have a big flap, you can't irrigate that bone debris away. Now you're going to increase your chance of a cutaneous fistula, which we've seen, you know, this rising cutaneous fistulas. 00:28:26:08 - 00:28:47:32 Speaker 1 And then the other thing is, if you don't have a big flap elevated, you can't protect the tissues with a retractor. And if you're just drilling till you feel it hit your finger. A lot of doctors are drilling through the dermal tissue. So now they disrupted that barrier. They get bone debris into it. And you know, again now they're a chance to get a good fissure that goes up higher. 00:28:47:34 - 00:29:12:10 Speaker 1 They overheated the bone because they can't cool it. And when they put the implant in, they can't check to see if they're overextended because it's covered up with a flat. You know, they'll just take their finger and push. Well, I could tell you, I felt as I goes, if you're overextended here, unless you're grossly overextended, you can't feel it like you might be overextended a couple of millimeters and you go push and you don't feel anything. 00:29:12:15 - 00:29:30:51 Speaker 1 Now, you go check with your, you know, elevator and you're like, oh my gosh, I'm overextended. But I didn't feel that I was overextended. So if you have a conservative flat, you wouldn't even know you're overextended if you didn't take a post op scan. You don't know you're overextended. And now the patient comes back for their follow up. 00:29:31:06 - 00:29:48:30 Speaker 1 You know, a week later, ten days, two weeks, however long people do their post-op follow ups and now they see, oh my gosh, no five millimeter overextended. And then they also get into trouble is they don't do anything about it. It's like, okay, if even if it was two weeks later and you see, I'm five millimeters overextended, hey, I need to go back in. 00:29:48:30 - 00:29:54:54 Speaker 1 I need to trim that. And they don't do anything like, oh, I'm just gonna watch and see. Maybe it'll be okay. That's when they get in trouble. 00:29:55:03 - 00:30:12:01 Speaker 2 How's the newer technology changed how you approach this? I mean, obviously there's some things you probably couldn't do ten years ago that you can do now. What? What is that shifted about? How you look at things and has that made everything better? Or are there some things you think have gotten worse because of it? What's your stance on that? 00:30:12:03 - 00:30:18:58 Speaker 2 I know technology is a very broad topic, but there's got to be some things that stick out to you. Specifically. 00:30:19:03 - 00:30:40:20 Speaker 1 If I'm thinking about technology in how it's been transformative, the first thing that comes to mind is 3D printing and digital design. You know, that is really revolutionized and changed things. So, for example, you know, I was on the era, we did everything analog and we, you know, put symmetries on and do the pickup and convert the denture. 00:30:40:25 - 00:31:07:34 Speaker 1 You know, they did, you know, thousands of those and you know, you I mean, I most of what I do now is travel, you know, around the world and mentor doctors and teach and you know, get to fix salvage cases and things like that. And it's a never see any analog anymore. Like almost nowhere. Everything is like literally 99.9% of the places I go to. 00:31:07:37 - 00:31:35:39 Speaker 1 Everything's digital. So I'd say and that has pretty much almost all benefit. Sometimes it has some disadvantages. I mean, sometimes I see some cases where they spend so much time on the digital because occasionally you have some. It's not cooperative scanning is not working right there, software issues or whatever, or it's difficult to scan and it's like, God, we could have already picked this thing up and had it converted in the end like an hour ago. 00:31:35:44 - 00:31:54:34 Speaker 1 But, you know, it's nice because you have the digital design. If you don't like it, you make a couple of changes. You can print a new one. If you have a fracture, you just print a new one. You know, you know, that process has been much easier. So, you know, for me, in terms of technology I use, I would say that number one. 00:31:54:44 - 00:32:22:51 Speaker 1 There's been a big change is, you know, everything's digitally designed and printed now. And, you know, I'll utilize that. I it's also, you know, there's there's been a lot of guided technology that's come about, you know, in terms of, you know, there's always been static guides. They've been around for a long, long time, you know, but now we have all the haptic guidance, you know, the, the, the x navs and the, you know, the, you know, the real time guidance. 00:32:22:54 - 00:32:54:06 Speaker 1 And then you've got, you know, robotics, you know, so and that's really helped a lot of people, you know, and a lot of people really love that technology and utilize it. And, and again, you know, at the end of the day, you have to if you look at the lit, the lit shows all the guided technology is all statistically superior to to freehand, you know, you know, lots of podcasts always let you know because it's click bait, the three hand versus guided debate. 00:32:54:10 - 00:33:14:13 Speaker 1 I was like, okay, if you get down to it, you look at the literature, statistically significant, clinically insignificant. I mean, it's it's across all the papers, you know, guided is going to win every time if you're looking at where you planned it and where it ended up. But if you look at, you know, clinically it's like clinically insignificant. 00:33:14:13 - 00:33:38:37 Speaker 1 You could freehand it, you could do it guided. It's still going to be able the the guide is always going to be in the the more accurate placement. But again does it matter if I'm in the exact spot I planned it in some cases, yeah. Ideally. But in most of this work, especially on on X, you know, we have a lot of freedom of movement on things. 00:33:38:42 - 00:33:59:46 Speaker 1 I mean, to be honest, you don't have to be quite as precise on it all on X type of case as you do for say like a implant. Number eight a highly esthetic zone with a high smile line, and you've got natural dentition all around it. You'd be, you know, really, really exact in your placement, depth, angle. You know, in all in X you do have a little bit more freedom. 00:34:00:01 - 00:34:23:10 Speaker 1 So but you know, guided technology there has been really helpful for many, many doctors. And, you know, I kind of get a little irked when people say, well, it's the standard of care now. It's like it's not the standard of care. You. Is it good? Yes. Is it the standard of care? No. You know, and you know, Cat scan technology. 00:34:23:10 - 00:34:44:08 Speaker 1 It's funny because that has even improved just the image quality. So much better. And, you know, in the past, you know, there were certain Cat scans that were better than others or CBBC, you know, and now when people ask because I get asked that question a lot, like, oh, you know what, what CBC t machines, I guess it's like, to be honest with you, at this point in time, it doesn't really matter. 00:34:44:08 - 00:35:07:46 Speaker 1 They're all such high quality now that to me personally, it's really the the viewing software that you like. You know how you can manipulate the images. You know, they all have different viewing software. It's it's like a whatever you like better. Then, you know, some Cat scans are faster than others. You know, some have bigger footprints of, you know, the space it takes up in your office, that kind of thing. 00:35:08:01 - 00:35:31:01 Speaker 1 But, you know, the image quality on all of them are amazing. And then in terms of implants, I mean, you know, there's all the implant companies been doing the same thing for the past 30 years. You know, all these new designs coming out, you know, has one been more revolutionary than others? I'd say no. If it was, everybody would be copying that same design. 00:35:31:03 - 00:35:56:01 Speaker 1 And they have for some aspects over example, in the zygote world, there were a lot of different designs, you know, and, you know, it'd be quite frank. A lot of people have over the years ended up copying the Norris design. In terms of having, you know, a long, smooth, you know, machine shaft. And you know that if you go look at the older designs, they weren't all that way. 00:35:56:03 - 00:36:32:15 Speaker 1 Now, most of the designs have that basic concept and, you know, have tweaks to them. You know, every company puts their own little personal spin on it. But, you know, the the thing that I also find a little irksome is when you have doctors or lecturers and they come out and they say only this implant works, and if you're using any other implant, it's garbage, which, you know, I don't care a lot, you know, and one, you do need to take things with a grain of salt because one, you know, a lot of these doctors that are saying this type of stuff are getting paid.. 00:36:32:22 - 00:36:34:13 Speaker 2 I say, who's sponsoring that lecture? 00:36:34:20 - 00:36:55:39 Speaker 1 Yeah. Or or they have residuals like they helped design that implant and everyone they sell, they get, you know, money back from it. You know, but to go out and say, if you're not using this and you're doing this technique, you know, you're inept or incompetent, you know, or doing it wrong, it's like, look, you can use all the implants work, right? 00:36:55:39 - 00:37:15:27 Speaker 1 You could use any implant. It's just, do you know how to use that implant? Do you know all the ins and outs, the tricks, the tips with it? I mean, you really need to know these implants, like the back of your hand. I mean, I've worked with, for example, the Norris zygote interrogates so long, I know every little tip and trick you could do with them. 00:37:15:30 - 00:37:40:46 Speaker 1 I mean, there's certain things we'll do with them where I will purposely pick a longer implant and trim five millimeters off of the apex of the implant before I even put it in. I will, you know, know that I will expect to get torque at this point because I know that implants so well and you need to whatever implant system you use, you need to know it that well. 00:37:40:51 - 00:38:01:46 Speaker 1 And that's another problem that I see with a lot of doctors now is, you know, they're mixing and matching and, you know, they don't get a good talk as they should have gotten, you know, or one implants designed to be placed, you know, a little bit beyond the apex. And this implant is not designed to be placed beyond the apex. 00:38:01:46 - 00:38:20:51 Speaker 1 And so, you know, they mix up the thing. So whatever implant system you use, I mean, one, you just have to know it in and out, up and down. And then you can make anything work, you know, but for people to go around saying this is the only system that's going to work, I mean, that's just no. 00:38:20:58 - 00:38:45:42 Speaker 1 And if you just blindly believe that, then that shows, you know, you're not being discerning. You're not, analyzing things. It's the same when you read an article. I mean, you read some of these articles and they're just inherently biased. And a lot of people don't read into that, you know, they don't know, oh, this doctor sponsored by this company or all the doctors on this study are all sponsored by this company. 00:38:45:44 - 00:39:05:49 Speaker 1 You know, we're all the doctors on this study are all part of this group. So they're going to be inherently biased towards this group and towards this technique. And, you you'd have to really be discerning when you're reading this and when you see some of the things in the literature, you know, is it comparing apples to apples? 00:39:05:49 - 00:39:29:56 Speaker 1 Is it comparing apples to steak, you know, like something but doesn't even match. But if you don't read it carefully, you'll you'll not know any of that. Or if you just read the abstract, you know, or to be honest, a lot of people don't even read the article, period. Their friend or the article their friend read the abstract, said something about it, you know, and they take that as gospel and, you know, you have to. 00:39:29:58 - 00:39:47:34 Speaker 1 That was another thing. I was really grateful for my period training because we read tens of thousands of articles, I mean, literally tens of thousands of articles, and really learn how to dissect them. And, you know, and then when I was editor in chief of the journal for ten plus years, you know, I edited and read thousands of articles. 00:39:47:49 - 00:40:05:44 Speaker 1 So, you know, you can pick an article and say, okay, this article is good. It's the study set up. Well, this article is crap. I don't even know how this got published. But you have to be careful on that. And if you're not, you can really get into a false sense of security on some of these things. 00:40:05:49 - 00:40:26:22 Speaker 1 Yeah. And again, you know, it's a very simple I mean, you could literally have a podcast be two minutes on this. It's literally, again, all of a sudden you should statistically significant guidance is going to win every time. And when you look at it in the literature. Robotic number one robotics always the most accurate. Two is going to be the haptic guidance. 00:40:26:30 - 00:40:46:03 Speaker 1 Three is going to be the static guidance okay. Fourth is going to be free hand. I mean all the studies show that there's no argument on that. But again clinically relevant all the techniques work. Right. And so and again I've been in offices where we did, you know, things guided. And for example a pterygoid guided with haptic guidance. 00:40:46:08 - 00:41:02:01 Speaker 1 They planned it. Everything comes out exactly, exactly what was planned. And then we go to put the multi-unit on it spins because there was the torque suck. So then what do we do? We go in, we freehand it, we change the angles, we follow all the anatomy with the things that we teach. And guess what? Oh my gosh. 00:41:02:03 - 00:41:25:10 Speaker 1 Now we got torque. You know, so it's good to know. Have that free hand back up. Like you need to know. It's like driving a car. I mean, you're not going to send your kid out in a self-driving Tesla or something without teaching them how to drive. You can teach them how to drive first, and then, you know, now that they know how to drive, if they want to put in self-driving mode, you can. 00:41:25:10 - 00:41:55:22 Speaker 1 But driving on my own, I feel like I had more control, you know? But same thing with the guidance. It's like, hey, if you know, if you already know how to do free handed and now you want to do guided and you know, then if you need to fall back on the free hand, you can. But the other funny thing is on these debates, when they talk guided versus free hand, you know, they talk about how fast it is when it's guided, but they never talk about the two hours of pre-work that went into it where, you know, I literally can have somebody walk in the door. 00:41:55:25 - 00:42:15:20 Speaker 1 I look at their Cat scan for two minutes and they're like, hey, let's go boom, we do the case. I didn't have to spend two hours designing implant placement. Missing that you missing, you know, again, comparing apples to apples when they talk about oh the procedure only took this long. It's like, okay, well, how long was your tree planning process that's never discussed, you know. 00:42:15:25 - 00:42:34:22 Speaker 1 Yeah. It took you 30 minutes for the case, but it took you, you know, 2.5 hours of pre-planning on the case. You know, I guess what, I also didn't have to pay a licensing fee to do the case. You know, you had to pay a licensing fee to use your product that you've already paid a ton of money for to do this case. 00:42:34:27 - 00:42:41:34 Speaker 1 You know, I didn't pay any of that. You know, you got to take all those factors into consideration, I think. 00:42:41:39 - 00:42:50:39 Speaker 2 Yeah, I think that I think that sounds like a pretty fair assessment. And one of the things I do want to ask if I forget is how did you end up getting connected with with us here at Evolve. 00:42:50:44 - 00:43:20:44 Speaker 1 Meetings and social media? I'm fortunate to where, you know, I get asked to speak at a lot of meetings and, you know, do a lot of webinars and that type of thing. And, just, you know, at various meetings we've met, you know, evolution, also interviews, you know, at one time I was, you know, one of the chief clinical officers for a very large DSO, and we had 700 plus doctors, you know, 400 plus clinics. 00:43:20:44 - 00:43:45:30 Speaker 1 And so, you know, you meet a lot of industry contacts through through that. And so, yeah, so, you know, we in end of the day, the world's become a very similar place, especially with social media. It's you're able to keep in contact with people and, you know, so meeting social media. Just prior to, no jobs. 00:43:45:34 - 00:43:47:51 Speaker 1 That's how we met. Yeah. 00:43:47:56 - 00:43:57:46 Speaker 2 It's one of the things I love about this industry is kind of how how everyone. So I want to say everyone knows each other, but it's a small world, especially the further you get from the from the chair. 00:43:57:51 - 00:44:08:08 Speaker 1 Yeah. In. It's funny because a lot of times you think you know somebody just because you saw them on social media, but you don't really know that person, you know? And. 00:44:08:10 - 00:44:12:06 Speaker 2 At least not until you go up and introduce yourself and sit down and interrupt their noodles. Right. 00:44:12:10 - 00:44:35:08 Speaker 1 Yeah. You need, I mean. Ideally you need to. And one hopefully, you know, if you are in a position like that where you are the one lecturing and you have people coming, you know, to you that, you know, hopefully you do take the time to, you know, be the type of person that hopefully ten years from now they're going to remember you in a positive light, you know? 00:44:35:10 - 00:44:54:46 Speaker 1 And again, I remember certain doctors that I met, you know, a very positive light because they were always very kind and sharing of their knowledge. And and then, you know, there's doctors that, you know, I don't think of in a very kind light because, you know, one there, you know, just not a very nice person, not a very good human being. 00:44:54:51 - 00:45:17:18 Speaker 1 They don't share their knowledge. You know, a lot of very, you know, a lot of arrogance, a lot of, just very bad attitude. Fortunately, we see with a lot of folks in our industry. And so, you know, you just hope that, you know, when you're remembered years down the road, you know, people remember you in a positive light, you know, as opposed to a negative light. 00:45:17:18 - 00:45:32:39 Speaker 1 And it's really just the way that you, you know, you treated people and, you know, hopefully help to lift them up as opposed to bringing them down. And you want to share your knowledge and, you know, just all around, be a good person, treat people the way you might be treated. 00:45:32:44 - 00:45:47:10 Speaker 2 I could not think of a better way to close this out than exactly what you just said. Thank you so much for being here. Where do people find you online? Where can they find your lectures? Your book? Where? Where you up? Are you on social media? I know we talked about it a lot. 00:45:47:25 - 00:46:07:18 Speaker 1 Yeah. I mean, I am on social media just at Dan Holtzclaw. And, you know, my books are on the easiest place to buy them on Amazon. Most of my lectures I do through noise, medical, whatever you're going to do, as long as you truly believe in it and you've got research to back it up, it's like you could do which every way you want, you know? 00:46:07:20 - 00:46:26:20 Speaker 1 And that's things like, I still respect people that do it both ways. Just if you're going to do it, truly believe in it. Like I truly believe in zygotes. I truly believe in pterygoid, you know? And you know, I'll defend both of those, you know, until I'm no longer practicing because, you know, I really believe it. I know the science behind it. 00:46:26:20 - 00:46:42:37 Speaker 1 I've seen everything firsthand. And so it's like, hey, if you're going to teach it, then just really, you know, believe in it. And even if I don't agree with what you're teaching, you know, if you've got the science behind it to back it up and you truly believe what you're doing, then hey, you know, I'm supportive of it. 00:46:42:42 - 00:46:49:08 Speaker 2 Excellent. Absolutely excellent. Doctor Holtzclaw, thank you so much for being a part of this. This is this has been a pleasure. This has been. 00:46:49:20 - 00:46:50:22 Speaker 1 Appreciate you. 00:46:50:27 - 00:46:56:42 Speaker 2 And I've learned a lot in our conversation here. So this is I'm really looking forward to what this episode turns into. Thank you for being here. 00:46:56:54 - 00:46:59:25 Speaker 1 All right. Well thank you guys for having me. Appreciate it. 00:46:59:30 - 00:47:19:42 Speaker 2 And thank you, everyone else, for tuning into this episode of the Evolution of Dental Podcast. Look for us on all those social media platforms and all the podcast platforms as the Evolution of Dental Podcast. Please remember to like, subscribe, share the show with your friends and drop a comment or send us a DM. If anything in this episode resonated with you, or if you have any thoughts with that generated. 00:47:19:46 - 00:47:22:32 Speaker 2 And please remember, never stop evolving.