In the lab community. Joe Mante, Western regional sales manager for Everclear here. We all know zirconia is a hot topic. There's a lot of information out there, but also plenty of myths that could lead to confusion and misconceptions. That's why I teamed up with Jeff Smith. I was director of Technical and Digital Services to tackle the questions we hear all the time, from strength and translucency to processing techniques. We've got the answers for you, so please join us for an honest conversation based on real world experiences with zirconia. Don't miss out! Watch now and get the clarity you deserve. Simply log on to Everclear, comm or connect using the QR code available on the voices from the bench webpage to listen to this webinar. Welcome to voices from the bench, a Dental laboratory podcast. Send us an email at info from the bench and follow us on Facebook and Instagram. Greetings and welcome to episode 387 of voices from the bench. My name is Elvis. My name is Barbara. Hello. What's happening? Barb. How are you? Down there in the great state of Florida. It's raining. It's in the 80s. We always talk about the weather. I think that we're the weather people on top. It's been a while. It's actually been a while. So let's get an update. Yeah, it's been in, like 98. And this week it's raining and in the 80s. So I'm a writer and I'm trying to look for windows when I can run today because it's Saturday. But, uh. All good. How are you? Yeah. Good. Really good. Um, we're actually getting a little break. We call it false fall, where you wake up and it's like in the 60s, and then later, by the end of the day, it's in the high 80s, but it's like fall for a while. So we take it one weekend. I like it, but does it go back to being super hot next week? Oh, of course it's just a fake fall. Yeah. Okay. It's it's a give us a false sense of we live somewhere nice. Well it is September almost. My God, I know, but that's not how it rolls around here. But speaking of running. Yeah, you inspired me last week when you bought your ticket to go to the race for the future. I waited a whole week in about an hour ago. I bought my ticket right to go to the race for the future. So in Fort Worth, Texas, September 14th, which is kind of cool. I'm hearing a lot of people are coming to join us this year that don't usually do it, because they have the five K option. I saw Mandy on Facebook saying she was coming. Yep. And she roped in about 2 or 3 other people in the Texas area to come join, so the more the merrier. So if you can hey, come out and join us. And if you can't, don't donate at all. It all goes to the Foundation for Dental Laboratory Technology. And of course, head over to this episode Shownotes for all the juicy details. I actually bit the bullet and became a sponsor. I was like, you know, I don't really want to beg people for money, so I'm just going to donate. So I donated, so I get my name on the shirt. Yay! Oh, nice. Yeah. Nice. And we get our name on the shirt, I think, too, right. We did last year. This year we didn't sell as many t shirts and stuff, so dang it guys. Yeah, well, I didn't really put a lot of effort into it, so it's kind of my bad. It's tough. I get a lot of people saying, where are the shirts? And I'm like, yeah, it's hard to be creative all the time. Yeah, but this week we bring back to the podcast, almost exactly two years later, prosthodontics doctor Brandon Kofod. Now, unfortunately, Barb, you are not there during this interview. Okay. It must be implant you're doing. Yeah, but since it's all about implants, full arch, same day surgery conversions, you weren't around to kind of remind me that I was running a little long, and it was time to wrap it up. Well, I do know that you like to geek out on that, so I'm sure it was an hour and what half? Not quite, but we did nerd out over it for quite a while. You see, years ago, Doctor Kofod invented the smart denture conversion system just to make his life a little easier. Well, here we are two years later. It's growing in popularity, and that's allowed him and his team to rebrand as smart on X and dive deeper into the parts in the workflow for a better day of surgery. Conversions. Sweet. Yeah, we started off talking about his clever omni butt and its ability to fit almost any situation better than a standard MUA multi-unit abutment. For those not in the for me. Yeah. Thank you. Yeah. Sorry. Okay. It was really for you. Yeah. Then we get into the exciting and much needed updates to the smart denture conversion parts with the new 2.0 line. And then we wrap up the conversation when I ask him why he's selling prefabricated dentures. When that goes against basically anything a prosthodontics would stand for. Uh oh. Did you push his buttons a little bit? All right, so join us as we chat with doctor Brandon Kofod. Voices from the bench be interviewed. We're extremely excited to bring back a past guest doctor Brandon Kofod. Welcome back sir. Oh. Thanks, Elvis. It's good to be here with you again. Absolutely. I was just looking it up. It has been since August of 23 when you came on. Oh, wow. It seems like ages ago. Well, I was going to say it feels like just because we. We run into each other periodically so it doesn't feel like it. Well, that's true. I just saw you in Chicago not too long ago at a cow lab, and. Yeah, and C and C and everything. I mean, you're getting around what's changed. Anything lately? Well, yeah. So we did. We just barely. I'm glad you asked that question. So we just barely finished a project that I have been begging my team to get done for, like, three years. Well, team, it's about effing time. So let's let's back up. So you're the guy behind Smart Denture Conversions. I've spoken highly of this even before we had you on the podcast. Long after. Love the system, but you're not really called smart denture conversions anymore. It's it's different. Yeah. It's better. It's, you know, technicians and change. You know, we're all like, what's going on? So tell me what you've been doing with this process since we had you on almost two years ago. Yeah. It's, uh, that's a very good question. We've been very, very busy. And, you know, we can't really disclose too much before it's ready to launch, right? So two years ago, all I could talk to you about was smart edge conversions. But now, two years later, we finally have gotten through the FDA process for our new abutment, the Omni. But you hinted on that at the podcast. I remember it was like a teaser. Yeah. So, you know, that was a years long process just to get all the data collected, to be able to apply through the FDA for a five 10-K. And knowing that that was coming down the pike, we felt like it was appropriate to rebrand ourselves rather than just known as Smart Ditch Conversions. As a company, Smart Conversions we we rebranded to smart on X. You know, that's kind of a play on all on X. Yeah, I love it. Yeah. It's funny to me how many people when I say all on X, they still look at me weird and they're like, do you mean all on four? And I'm like, well. Sometimes it's fine. Yeah, sometimes it's other systems, sometimes it's six. All on X kind of covers it all. Yeah I love it. Smart on X yeah yeah so smart on X. Just playing on the on X theme. And you know smart edge conversions is a system that makes the provisional ization at the time of surgery so much easier than the conventional way of doing a denture conversion. So when I first came up with a product, I had no no vision for expanding into additional products. So it just made sense to name the company the name of the product that I had just invented. Right. Sure. I mean, you initially made this just for yourself, right? Yeah, exactly. It was just a desperate prosthodontics trying to make life easier in my own practice. And so, you know, not having much business or marketing acumen, it made sense. Well, it named the company after the product, so that's why it's a great name. There's no fault in that initial name. I mean, it works perfectly. Yeah, absolutely. I mean, it achieved its purpose, right? So you're referring to the business, you're referring to the product, and it just helps everybody understand what the product and what the business is. It's been interesting to me how many people consider. Smart Denton conversions as diametrically opposed to a a digital workflow. And that's just always just been very interesting to me. So when I say smart conversions, people automatically those who do a digital workflow they like disregard the product because they're like, oh well, I'm digital. It's like, well, oh yeah. So we ran into that problem as well, and not wanting our newer products that aren't just focused on the actual conversion of a denture. We didn't want those to be conflated with the analog workflow. It just made sense for us to rebrand as Smart on edge. Yeah, and it paved the way for us to be able to bring additional products that aren't just making the analog conversion process easier, but focusing on making all on X easier and just more predictable. Well, that omni abutment, let's start with that, because that was the next thing that came out, right. I mean, well right. Came in big. Yes. Yeah. And that was a that was a really huge undertaking for such a small business. I don't know how many we have on staff right now. I think it's like ten people. Right. So we're a small business. How many do you have when we talk? Two years ago. Uh, three. Yeah. There would have been like five. Wow. We're a small business. And. Sure. Which is possible to do, because we're also small parts, right? So small parts, small business. But getting through the FDA process of of claiming substantial equivalence to products that are already on the market, that is a regulatory nightmare for a small business. It's crazy and it's also a very expensive process, so it took us a long time. I mean, just logistically trying to figure out what that process is because good luck finding it online, how to like conceive an idea. And then what are the regulatory processes to get it to the market? It is. Did you hire somebody that knew the process we had to hire. Now we had to prepare a consultant to help assure that. And, you know, that's a very expensive process or a very expensive endeavor. But he was very good. In fact, his name is Joe Azari. He was our consultant to help us through the FDA process. And that was very, very helpful. It was a worthwhile expense. Did he specialize in dental or. No, no, just FDA and general FDA in general. He has done some dental work, which made it a little bit easier. But you know, when you know the process, then you can apply it across specialties medical or dental. Yeah. But it is a it's a very challenging thing to do if you're just a, you know, clinician like myself trying to figure things out. I mean, we've had multiple people on this podcast talk about the headaches and the costs that go into any of them. Yeah. Which, I mean, I guess I can see why it's necessary, but at the same time, does it need to be so hard? Well, you know what I wish. In fact, I think it would be a very interesting main podium speech on any at any of the dental conventions would be what a small business should do with their ideas, like what if you have a really good idea of how to make improvements within our industry? This is how you do it, and not just leaving it up to the big corporations to try to solve our problems, because they're not going to do it in the pursuit of our best interests. They're just going to be doing it in the pursuit of their best interests. Oh yeah, it's like milling abutments. Now, nobody wants to go through the headache of getting that FDA right. So they partner with a company and buy all their stuff, right, to fall under that umbrella. Yeah, I think it would be very good to educate all of all of us, because every single one of us, technicians and clinicians, we're all struggling with the same things, and we all have ideas about how to make things better. But those ideas oftentimes just kind of get stuck in limbo because you don't know what to do with an idea. And I was just a guy lucky enough to have an idea, and I met the right people along the way who were able to make it happen. Yeah. And your previous episode, we hear about that story and, uh, the neighbor, I think, and the and the guy that just happened to be a machinist, and I mean, it all kind of worked out. Yeah, but the apnea abutment. It's a multi unit with changeable angles. Yeah I mean I guess that's the best way to say it because most systems you're stuck with the zero, the 17, the 30 and you're stuck with, you know however many points of rotation that you have depending on the system it's very limited. Yeah. I imagine one day you said there's got to be a better way. Well, the way the omnibus came about is a funny story. My oral surgeon had built out a big, like, heart surgery level surgical center. Ambulatory surgical center. Yeah, where we would bring patients to do ambulatory surgeries, but full arch surgery under general anesthesia. And it was really awesome. Because of his connections, the implant reps were always coming to him, asking him to try their systems. And so one of our implant reps, I won't name the company, but one of our implant reps came and asked us to use their new system, to which we said, all right, we'll give it a try, but we're not going to buy these parts just to try them out. If you want us to try it, you provide all the parts. So we said, oh, absolutely. Give me. Yeah. So he brought all the implants. He brought all the and I'm putting air quotes. You can't see it but I'm putting all this. Yeah. Yeah. So he brought all the implants, all the multi unit abutments. And I brought my smart edge conversion system. So this is a pretty challenging case with vertical maxillary excess and very thin maxillary ridge that we were working with. So rather than doing all on six, I asked my surgeon to place eight implants, which he was more than willing to accommodate. He lost count. He gave me nine. Oh, geez. And, uh, in addition, the alveolar ridge being thin, it was also very flared. And you could only put these implants, but in one angulation. Right? Yeah. Never an ideal one. Yeah. My workflow, my workflow was my surgeon would replace the implants, and then I would jump behind the patient and start calling out which which abutments I needed. Mhm. I start calling out I need a 30 degree, a 30 degree, a 30 degree, a 30 degree, a 30 degree, a 30 degree and a straight right. So I just they were all 30 degree angles. Yeah. And I look up at my sales rep and he's white as a ghost. I'm like, uh, what's up? And he says, I have two, seven teens and the rest are straights. What? Yeah. And I'm like, oh well. Luckily smart engine conversions. I knew I'd be able to accommodate all those divergent angles. It wasn't that big of a deal. I knew I'd have screw channels coming out the facial surfaces of the prosthesis, but I also knew that they would be small screw channels. Yeah, easy to plug. Easy to plug. So it's not that big of a deal. Not ideal for the final restoration. So I knew that I'd have to after integration, I'd have to swap out the abutments. But my assistant with me was a dentist trained in Cuba, so he didn't have a US license. So he was assisting me at the time. Yeah. And he looked at this problem. And while I'm in the, you know, in the other operatory trying to convert this prosthesis, he's trying to describe to me what is the Omni. But he says, wouldn't it be cool if you only needed one abutment and you could change it into any direction? And I just wasn't in the mood to talk about anything. I was so frustrated. I'm blowing holes out the facial hair, dude. Exactly like shut up and let me work. No. Anyway, that's that was the instance that led to the creation of the Omni. But but I had kind of dismissed it as. That's impossible. Shut up. So a couple months later, my engineer who helped me with smart conversions, was in the office with his mom, and she just needed a denture realign. No big deal, right? Yeah. And so I'm working in an adjacent operatory, placing retraction cord or something like that. And my Cuban assistant says, hey, can I go talk to Charles about my idea? And I said, uh, sure, whatever. So, yeah, he's in operatory two talking to Charles about this, this swiveling abutment and the benefits that it would provide in full arch fix, blah, blah, blah. And I all of a sudden now I'm not under the stress and the frustration of the situation I was during the surgery. And so I'm listening to this thinking, oh my gosh, that is genius. That would be amazing. So I get up out of the chair and I go over to operatory two, and I just peeked my head and I said, Charles, that's a really good idea. Oh, there you go. So that that happened way back in like 2021. Yeah. But it's no small feat here. How did the practical come together? You know what I mean? Yeah. So it all starts with. It all starts with ideas. And then you have to provide figure out how it works. Yeah. You have to provide clinical parameters that idea needs to adhere to. Right. And so the the big thing for the Omni but being a non indexed abutment the big thing for that the big clinical parameter was you had to be able to re tighten the locking mechanism through the prosthesis. So that's like the big the big clinical parameter. If anything ever comes loose, you remove that prosthesis and that abutment moves from its position. You have to be able to tighten it through the prosthesis. And so I gave my engineer all those parameters and he started working on designs. And you know, the designs actually happen really quickly. And then you go into manufacturing and you look at manufacturability. And we went through several iterations to make it more manufacturer and also meet up to the clinical parameters. So finally we have an actual working prototype. Now how do you get it through the FDA? Well, even even before then I'm just curious. So you screw in and there's basically like a ball top. And then on top of that is the, I don't know, easiest way to maybe like the tie base shaped top that rotates around that ball close. Yeah. So the way I like to describe the omnibus is it's a ball abutment like it is a ball abutment okay. With like an odd secure or something. Well I don't know secure but. Oh but you know, it's a ball abutment. It looks like a ball abutment. And then we permanently attach a swivel base that looks like a multi-unit abutment. So rather than a ball abutment that has, you know, resilient attachments that can click on and off how they're using removable appliances. Yeah. The omnibus is a ball abutment that has a multi-unit abutment retained to it permanently that can swivel around that ball but not come off. I'm falling off. And then there's an orientation. Screw that. Tighten. It's like a set screw. It sets that swiveling component to the ball and just uses friction forces to keep it in position for clinical convenience. But then the prosthesis itself is a rigid splint and keeps all the abutments together. So our challenge, our challenge with the FDA was how do you test this as a multi-unit abutment? Because all the multi-unit abutments, or any abutment for any implant system has to go through a mechanical test called the 1481 test, which is embedding an implant into a bone simulated material with three millimeters of bone loss around the implant. Interesting. Yeah. At 30 degrees, or actually, it's plus ten degrees from the amount of angle correction. So a 30 degree multi-unit abutment would it be have to be tested at 40 degrees. Oh yeah. Okay. So that you're not perfectly in line with the piston. And then you do a dynamic fatigue testing and you have to test it through 5 million cycles. And so you're creating a fatigue curve and you're trying to discover the fatigue properties of the abutment. Right. So you need to see four samples fail before 5 million cycles, and four samples survive 5 million cycles. And so what is the amount of force required to break the sample prior to 5 million cycles? And what is the maximum force that it can survive beyond 5 million cycles? And that 5 million cycles is just meant to simulate a period of time in use in the mouth, right? Like it simulates chewing. Well, the dynamic testing is 12Hz, which is 12 cycles per second, where you're loading and unloading the abutment. Right. So you're essentially tapping on the abutment and applying a certain amount of force. Wow. And then you're trying to see what is the amount of force required to break it. What is the amount of force that it can withstand breaking up to 5 million cycles. Mhm. Yeah. And but we had the problem of okay we want to claim substantial equivalence to a standard multi-unit abutment. Yeah. You can't be subpar. Right. And so how do you test our abutment knowing that. Well yeah if you apply like let's say 200 newtons of force to this swiveling component and you'd do it as a single unit, of course it's going to move. Mm. So is that the failure or is what's what's failure here. So we were really stuck in limbo, not knowing how we could test it and claim substantial equivalence until we finally just, it dawned on us, know all we need to do is test it like a ball abutment. So take the swiveling component off and test the strength of the ball abutment, and then do a separate test, which is a modification of the 1481 test in its indicated use, which is a minimum of four implants. Oh, I get you so that we can so that we can then test the ability of that swiveling component in its intended use, which is four of them. Support. Exactly. Yeah. And does it move under functional conditions. And so, you know, it just took us a long time to figure out how to provide the data to the FDA to be able to claim substantial equivalence to a standard multi-unit abutment, which we finally did. I was going to say, how do you explain that to someone that doesn't understand dentistry? Right. You know what I mean? That's like, got to be hard, right? So that was a it was a really, really big task. And that's why it took us since 2021 to get the abutment available to the public. And so in preparation for that, there was the name change to smart on X simultaneously. We're a small team trying to manage many very big projects. So the omnibus was a all hands on deck, very large project for all of us in this small company. Yeah. And we finally got it through. And man, we were super excited. And meanwhile, simultaneously, we're working on another three year long project of what we call smart engine conversions 2.0. Yeah yeah yeah. But first I want to find out how did they not me, but I mean it hit the market. What is the reception? Are people loving it. Is are they reluctant because of what it is? Is it taking it hard to sell them on a few cases? Yeah, absolutely. All of the above. Right. So there's a lot of a lot of interest in it. Like, oh my gosh, that looks amazing. I can see why that would be awesome. But. And I was going to say. But yeah, but you know, you don't want to be the first clinician to try something and then have it go completely haywire and you're on the hook. Sure. I'm totally sympathetic to my colleagues and them being worried about testing or trying something new like this. However, to reassure them, I say no. It is substantially equivalent to a multi-unit abutment. The question they always ask me is, aren't you worried about it breaking? And then I always ask them, are you worried about your multi-unit abutment breaking? And of course they say no. They say no. And I ask, have you ever seen a multi-unit abutment break? I haven't, I have. Oh, you have? Absolutely. Oh, yeah. I always see everything else break. So. And that's a very good point. Elvis. Everything breaks. Yeah. In fact, implants break. Oh, yeah. One OEM parts break, no matter what the sales reps tell you. OEM part break. Absolutely. No. I have seen all kinds of fractures. Right. So one of my favorite images that I've ever been able to capture was a patient came in. They had had a guided surgery done at the VA and three implants on the right side failed during the osteo integration period, which left him with his left side intact. And they, you know, the patient probably didn't want to go into a removable appliance. And so they preserved from tooth number eight to tooth number 14 as a fixed prosthesis. And then they put them into a partial denture to replace three through seven. Interesting. Very interesting. Because now you're using these implants in such a way that they were not designed or engineered to be used. You have a huge point on them. You have a huge cantilever on them. Yeah, that removable prosthesis that's constantly pumping against that conversion prosthesis. And so the patient shows up in our practice. And he had three types of fractures in one prosthesis. It was so cool. I mean not cool for him. Not cool. Not cool for him. I I'm sympathetic to him. But for me, getting this picture was amazing because I always drive home this point, everything breaks. And so in this one picture you see the prosthetic screw broke. So on the implant, which is obvious. Yeah, yeah. Site number 14, that prosthetic screw broke. So that was probably the first one to break. Yeah. And then the middle implant. So let's call it site number 12. Yeah. That multi-unit abutment. It was a straight multi-unit abutment. The multi-unit abutment threads broke deep in the implant. Oh it just sheared the threads. Yep. Just sheared the threads off. So right below the the taper of that straight multi unit abutment, the threads sheared off. Wow. And then the so that must have been the second one to fail because the last one. In site number nine. The implant broke mid fixture. And so I have all of this in one picture just to prove the point that everything breaks. Yeah. So if you're afraid of something breaking get out of dentistry. Run for the hills. Yeah. How was the restoration? Was it still in one piece? Well. Well, no, because they had sectioned off number seven through three. Right? Yeah. But other than that, yes, the the fragment that they had preserved that was still intact. Props to that lab. Props to that lab. However, I'll say, like, of all the things that I want to break, the prosthetic screw is an easy enough problem to retrieve. Yeah. That's what. That's what you want to bring. A broken prosthesis is easy enough for me to manage. But when things break deep down in the implants, like screws under tension break deep down in the implant. Sometimes irretrievable, but sometimes they're not. When an implant fixture breaks, there's no fixing that. Like it's a new surgery. Yeah. So we kind of have to think more along the lines of, okay, knowing that everything breaks. How do we engineer things to be easy fixes? So when people ask me, why aren't you worried about your abutment breaking? I say, actually, I'm not, because the forces it takes to break the abutment are above clinical levels. However, I'm not so naive to think that it will never break because I see things break all the time. And they're not my things. Like you can't say, oh well, Brandon, maybe you need to do some continuing education because it sounds like you have a problem. No, these are other patients coming from other practices into my practice for me to have to fix. Yeah. You're not starting these cases. Exactly. So I know I'm not the only one who sees these types of fractures because they're coming from other practices into my practice. So anyway, I'm not so naive to think that things won't break. So you just want to make sure that when things break, they break predictably and they break with easy protocols to remove. And that's one of the cool things about this omnibus, all of our testing. It shows a predictable break pattern, which is at the neck of the ball. Oh, the ball breaks off. Yeah, the ball breaks off. And so what you're left with is essentially a cover screw in the implant, which means you don't have a bunch of junk getting into the implant and causing a possible cause of infection. You can retrieve that cover screw out of the implant very easily with very available retrieval tools. When you test a multi-unit abutment, guess what breaks the thread? Well that's a that's a straight multi requirement. Oh, but when you test a 30 degree or a 17 degree, guess what breaks the implant? Absolutely. I don't know. Every time. Is it really every time you're putting 30 degrees forces basically prying on the side of an implant? Right. But now keep in mind that this test setup is not clinically relevant for all on X because you're only doing one. You're only doing one and you're using a multi unit abutment. It's not used as a single abutment. And so I get that the setup is not clinically relevant. However the data is pretty interesting that when you test it under those conditions it's the implant that fails. So what you don't want which which you once said, which you don't want. Right. So yeah. Interesting. And anyway, so under the conditions of the implant or the indicated use for the omni, but the abutment survives well beyond what would be clinically relevant forces. So yeah. Am I worried about the abutment breaking. No I'm not. I have hundreds of these omnibus in use. I am not worried about the abutment breaking. But I'm not so naive to think that it won't ever break because everything can break. So what's reassuring me is that if something breaks, there's a very easy way to retrieve that abutment out of the implant. Way easier than a screw. Deep down in the implant or an implant fracturing off completely. And when it does break, you don't have to have a bunch of parts in stock. One fits all. Absolutely. If you don't have a 17 or a 30 or whatever, you don't need that. So that's a huge, huge it's a huge benefit. Now people might say, yeah, but how are you going to get it to fit the prosthesis. Because it's a non index part. And again that goes back to the first clinical parameter. That is an absolute requirement for the abutment is you have to be able to re-engage the locking mechanism through the prosthesis. So let's just say an abutment breaks which is unlikely. But that's what people are worried about. So let's just say that happens. Yep. Easy to retrieve the portion in the implant because it breaks above the platform. Yeah. And then I just slot it and take a flathead screwdriver to it. Yeah. It's actually easier than slotting it. You just drill a hole into it. Yeah. And then you use an easy extract from the implant. Salvaged cells. These really great kits called the Implant rescue kit. And so you can just drill a hole in it with your 245 carbide burr and then reverse it out very easily. So it's like it's super easy fix and then you don't have to think about, oh, the orientation of the abutment that has to go into it. Or is it a 17. Is it a 30. Is it a straight blah blah blah. You just talk your omni buddy in, you loosen the locking mechanism, you put your prosthesis on over it, and then through the prosthesis you engage the locking mechanism, torque that to 25cm and then deliver the prosthesis. It's a very easy thing to do. Interesting. The head locks onto the ball at 25. Yeah. You don't hear that number too often. Right, right. So what I wanted to do another clinical parameter is I wanted to stack the torque forces so that we talk the abutment to the implant at 35 newtons centimeters. The locking mechanism is at 25 Newton centimeters. And then the prosthetic screw is at 15 newtons centimeters. Oh I like it. Yeah. And so that's just easy to remember because it's all in units of ten and 30. Yeah 25 to 15 I like it I haven't seen them out in out in the world yet. I'll have to send you a little model with it. Yeah. Please. You can play with it. Yeah, I'd love to see it in use because sometimes just choosing those angles, you want something in between sometimes. Oh, or a little bit over, you know, a little bit more lingual would have been nice, you know. Totally. But. So I could go on and on and on about the importance of multi-unit abutment selection to establishing the ideal intaglio contours for your full arch fixed prosthesis. Yeah, we could we could spend a full two hours. Yeah. Just on the importance of multi-unit abutment selection and arch fixed. And it's unfortunate I see way too many fixed prosthesis coming through my practice. Not I didn't do them. They come to me after having things done where the contours are not hygienic. And these poor patients who have spent, you know, their their life savings, $30,000 plus and they've ended up with a prosthesis that just cannot be maintained. It all stems back to improper planning a lot of times, but also just improper multi and abutment selection, the reigning thought process for many, many years. And it stems from the conventional conversion and also from the 14 to 1 test actually. But the remaining thought has always been to parallel your multi-unit abutments. Well yeah. And that's because in the denture conversion process, the conventional conversion process, you have to obliterate your denture. The more those implant or multi-unit abutments diverge. Oh yeah. Yeah. What does he call them? Big holes. Yeah. Big holes. And it's because of the projection error of the divergence. You know, you put a big tall temp cylinder on those multi abutments that are diverging. And by the time you get through the occlusal surface of the denture, you've got a huge hole there because of the divergence. And so to avoid doing that you want to parallel your multi unit abutments so that you can be more conservative to the denture that you're converting. However, that has adverse effects on the contours of your restorations. Ideally, and I teach people that in a single unit restoration, where would where would you want to see your screw channel? Let's say it's a tooth number eight and you're doing a screw restoration. Where do you want to see your screw channel? It's right in the cingulum of that anterior tooth. Okay, well, what about a posterior tooth? Where do you want to see your screw channel? Dead center in the occlusal table. Right. Yeah. Okay, so then the the question is. Well, why? And then they might say stuff like, well, to, to centralize your or to optimize your occlusal forces along the long axis of the implant. To which I say that's not what's happening in an anterior tooth. Ah. So that can't be the answer for why we do it that way. Sure, that that works for a single unit in the posterior, but what about in the anterior? Why do we do that? Why don't we put a screw channel ten millimetres lingual to the free gingival margin of an anterior single unit restoration? Well, because if you did that, you then have to create a non hygienic contour to get the aesthetic surface of the tooth proper. You have to warp the shape of the antagonist of that restoration from that position to where the tooth needs to be. So with full arch fixed, really what we ought to be doing with our multi-unit abutments is directing the screw channels into this cingulum of the anterior and the occlusal table of the posteriors, so that we achieve optimal contours, sleeker designs, rather than having these, you know, concave contours or very don't worry about paralleling them. Exactly. And so what the what the omnibus allows us to do, like you rightly identified, we're not limited to a straight, a 17 or a 30 and having to be dependent on the timing of the implant. No. It makes surgery so much easier. You just get the implant in and get it to the point where it's stable. Don't get greedy and try to turn it a little bit more for this reason or that reason. Just get it stable where you want it. And now don't think about straight 17 or 30. Don't think about heights or anything like that. Just screw in one abutment and then your singular objective in orienting that abutment. Once it's delivered to the implant, your singular objective is to direct the screw channel into the cingulum of the anterior and the occlusal table of the posterior. And in doing that, your antagonist contours will be optimized. It's awesome. Yeah, it makes sense. So the freedom that I get from the omnibus is so amazing. I absolutely love it. I want to make sure we touch upon Smart Denture Conversion 2.0. Yeah this is recent right. This just recently kind of yeah yeah just launched just barely launched. Yeah. So I'm super familiar with I guess is now considered 1.0 or legacy. I don't know what you're going to call it, but I mean, just seeing what's new is pretty exciting. Yeah. Yeah. Like I said, it's been a project we've been working on for over three years. Yeah. Okay. So there are a couple things that people always complain to me about with my system. And it's so funny to me, like, remember how you had to do conventional conversions? Yeah. So yes, I've made I've made things so much easier for you. And now these little, little things, we want it easier. We want it easier. Oh, this is incredible to me. So anybody who's ever heard me teach smart engine conversions, they know that I harp on the importance of pre coding the typeface and covering the typeface and the separable fastener with your with your pickup material. I always promote PMMa acrylic as my preferred pickup material. So I pre-cut with PMMa to lock my separable fastener into my tie base, so that when I go to do my pickup, I don't have to expect a viscous material to find its way into the nooks and crannies of the undercuts of a tie base. Yep. But just has to make contact with that pre coated tie base. And then bonds. It bonds and pulls out. It's very, very predictable. Even if you don't get 100% coverage of that tie base in the pickup, it's nice and secure. You don't have any wobbly tie bases or temp cylinders. I love it because I can't tell you how many times I've been out in my personal garage pre coding tie bases, because my wife won't let me do it in the house for surgeries in the morning, right? I love this. So so we've been cold out there in the winter. Yeah, yeah. So we've been working on getting these tie bases pre coded. For three years now we've gone through several iterations several ideas right. Yeah. So I had as a clinician I had my ideas of doing it. And then my engineers were like well that's a pretty wonky way of doing it. So here try try it this way. And so we came up with this awesome, awesome solution, which I absolutely love. It's a shell of polycarbonate. It's a clear polycarbonate. Okay. And it is secured to a tie bass. The Thai bass has a one point, I think it's 1.8mm polished collar. And then the adherent surface of the Thai basses, I want to say like three millimeters tall. Okay. Yeah. And so the shell is about a millimeter thick. And so the Thai bass height, all in all, is about 5.5mm tall. With the with the pre coat in place. That was one of my clinical parameters that I gave my engineers saying okay I want it pre coated. But I also don't want to add height to the part that I'm trying to pick up. That makes sense. Yeah. We're all fighting for space. Always always the fight right? Yeah. So then the other clinical parameter that I gave them was it has to bond with poly methyl methacrylate, because that's the material that I choose to use for my pickup for various reasons, not the least of which is the handling properties of PMMa are so much better for simultaneous re line of the denture and pickup of the tie bases. Mhm. Yeah. So I just, I really wanted it to be bendable or have a chemical adherence with poly methylmercury. Yeah. And the other clinical parameter I gave them was I would love for the pre coat to have a little handle. That makes it easier for me to put in place. So I don't need a driver. I just pick up this piece with a handle, screw it into the multi unit abutment and then snap the handle away. Oh how tall is the handle. The handles like 15mm tall. 15. Wow. Yeah. So it's just very easy to hold on to and then yeah snap it away. So basically the handle is made out of polycarbonate. It's yeah. It's all one piece that acrylic bonds to. Well the handle gets broken away before you do your pickup. I understand that, but it's still made out of that same material. Correct. That's interesting. Yeah. Yeah. So the the parts that we manufacture are the threaded post, this handle and polycarbonate shell and then the tie base And then internally, we have a manufacturing process that puts all those three parts together and makes it ready for for pickup. Now, some of the advantages to the polycarbonate. Anybody who's used smart inch conversions 1.0 or smart engine conversions legacy. I like that. Yeah. I think we'll have to pay you a royalty for the use of Martin Conversions legacy. But one of the complaints that we get from people is they struggle to get the peak cap. Ah. Come on. Yeah, I struggled. I spent a lot of time. Yeah, yeah, well, there are good days in bed. I'll say that. Right. Well, so that peak can be tough to get to. And I've always had this technique by hand using a pin vise. And then you rotate five times. Oh, yeah. Right. So I remember it. Yeah. You remember that training? You wiggle it. Yep. Five times. You push. Yeah. Don't push. Yeah, yeah. So I'm I went to doctor Nick Abbott's practice in April because, you know, he's a friend of mine. He's a smart conversions proponent. And he was really interested in the Omni. But so I said let me come out to your practice and we'll do a case. So in April, I went out there and I was showing him the omnibus and he's, you know, expert at everything. So it it was not really necessary for me to be there. However, I was glad to be there because he taught me a trick about removing that peak cap. Yeah, that just blew my mind how easily he does it. And the secret has not been shared. Why? Right. So the secret is with an NSC handpiece. I know you can actually put that third drill rather than putting it in the pin vise hand instrument. You can put it into your handpiece. Yeah. And then turn your handpiece down to four. Yeah. And then you go down that screw channel and you can just with light pressure you can feel it and gauge that peak head. And then you just withdraw and it comes right out. It just it blew my mind. I was like, oh my gosh, I have been ruining people's lives by not teaching this somebody. I think it was a doctor I worked with actually used this handpiece to get it out, and it went right out and I was like, well, that's on you, buddy, because I don't want to. That's not protocol. And I'm not doing it. Yeah. And that's what I mean. Like, I have been very staunch about no, this is the protocol. You run the risk of damaging something if you do, if you do tie base or pushing it out. Exactly. If you don't do it by hand, you run these risks. But then when I saw him do it, I was like, oh my gosh, not only is that much easier to teach, but you're doing it at such low RPMs. You're not generating heat in that tie base, so you're not going to be pushing it out. I yeah, it blew my mind. And I was just very grateful for Doctor Egbert hosting me in his practice that he could teach me how to more efficiently use my own invention. Right. Yeah. So with the 2.0, is that screw still part of that process? I mean, do we still have to get that little peak part out? Well, it's not peak anymore. Right. So the polycarbonate actually goes down into the temp cylinder, the tie base. Oh. And engages the threads of the stainless steel threads of the separable fastener. It's part of that exact cap. Exactly. Oh, interesting. Yeah. And so because it's part of that cap, there's actually no tension. The legacy smart edge conversions peak cap. Yeah. That is resting on the screw seat inside the tie base. And that's how you get it to hold the tie base in place. Yeah. Well when we do it as a polycarbonate shell, the part that's holding the tie base down to the multi-unit abutment is the separable fastener threads. And the part of the polycarbonate shell that's resting on the top of the tie base, not inside the tie base. And so when you go to do your drill out procedure that polycarbonate machines so easily. So it's very easy to drill out. And then since that screw head is not sandwiched against the internal type or internal screw in the tie base, then it just comes out so dreamy. Mhm. Like you don't even have to go through the, the turns and the twists and the pushes. And I mean we still teach that because it's handy techniques. But yeah oftentimes it's just going to come out in the drill. Oh that's amazing. Yeah. So no more pre coding. Very easy to handle with that breakaway handle. And then the improvement to the lack of a peak part and making that polycarbonate easier to drill through. And then having it not resting on the screw seat. All that just improves some of the major pain points that people were experiencing. Yeah, I agree that major pain point was getting those little peak parts out. Yeah. Are you gonna put legacy to bed? No, no, because with the pre coat, that solves the problem for people who are using the system as a complete system. But there are still people who use our separable fastener technology, but they want to use OEM temp cylinders, and they want to cut their OEM temp cylinders down to the right height and just use OEM temp cylinders. Okay. Then you need to have a separable fastener. Oh I see. Yeah. But for those who, you know, just use the optimized version of smart engine conversions to me. Yeah. The kit the pre coat makes the most sense. Eh. It's like the same price. We didn't raise the price on this. Better improvement. What? It's just this was. You did mention you're not good at business, right? Yeah exactly. I'm just trying to make things easier for my fellow trench warriors. Right? Yes, yes. And we appreciate you doing all this. Oh, it's it's fun. Oh, the other thing that we've done to improve the protocol, this isn't like separable fastener product, but the protocol is. We also make the silicone dams available with a vinyl sheet adhered to the silicone, so that you can imprint the position of the multi unit abutments, punch through those imprints, and then just peel the vinyl away and put the silicone down over your tie bases. Oh, instead of doing the paper one right, then. Right. I can never get that to work. I want to be honest. I could never get it to pick up. Yes. So I think you'll like the vinyl. Again, we'll have to say nice to some so you can play with it. Yeah, I'd love to try that. Something I really have been questioning. I'm going to use that term questioning these prefabricated arches. Uh, what the heck, man? That's like everything against dentistry. I know, I know, like, it reminds me of those commercials you see online of, like, you could buy the snap on teeth, you know, like, seen on TV. And I'm like, what is he thinking, right? No, totally. And like anybody who just sees it, they dismiss it as heresy. Right. And yeah. And remember, I am an Air Force trained, board certified prosthodontics under the direction and training of Rod Phoenix and Charles DeForest, who wrote the book Stewart's Clinical Removable Prosthodontics. But you broke them down to small, medium and large. No. So those stock dentures. I'm not the first person or the originator of the idea of a stock denture. Right. So I need to give credit where credit is due. Good shit dentures and laurel dentures. Those are predecessors to my product. And I was working with laurel dentures. Doctor Lawrence, he's a great man, great oral surgeon, very visionary. But I told him I didn't like his dentures for specific reasons, and I couldn't use them for specific reasons. And so I had to make my own. That resolved my concerns about his stock dentures. His focus had always been on using them as the ability to make a thermoplastic denture, so you can make an alginate impression of a patient's mouth and then boil these dentures, adapt them to the alginate cast, and then you have a denture ready to go. Oh, I didn't realize they boiled and fit. Yeah, I didn't I don't know much about it. Interesting. Both good fit and the oral dentures were designed for that intention. Well, my intention is all in full arch fixed, right? You think of Smart Olympics as a all on X solutions company. So my focus is how can I have something ready to use for fixed? And one of my guiding clinical principles is I don't want to convert anything with denture teeth, because denture teeth subtract from the denture based material Ill. The most likely thing to break in a large, fixed provisional restoration is the denture base, and anything that subtracts from the bulk of the denture base is weakening the denture base. Yep, 100%. Therefore, denture teeth are subtracting from the bulk of the denture base and hence weakening the prosthesis. Which again is another reason why I prefer having short tie bases, because I want to preserve as much of the bulk of the denture base as I possibly can. For strength purposes. Yeah. So I made these stock dentures to be milled PMMa teeth with pink PMMa processed to it, ready for the pickup. So there's a big deep channel in the integrity of the denture, so that the parts and pieces have the space already incorporated into the denture. For me to just add acrylic and then pick up the parts simultaneously with a re line of that stock denture. What blew my mind was how many patients you can actually fit into a ready made stock set of teeth. It it blew my mind. It doesn't make sense to me. It really doesn't. Like, why would you not go through the process of. Creating something to fit, ideally for the patient. I mean, are these like patients that come in and say, I want an all on X, but I want it right now? I mean, so Elvis, you laugh. But two weeks before Memorial Day, I spend one day a week at a practice down in Fayetteville, Doctor Jones at Sandhills Oral Surgery and Implant Center. He's an amazing oral surgeon. And I go down there. I have my own practice, which keeps me very busy, but he asked if I would come down and spend one day a week with him and his practice to offer him prosthetic support to his patients. And I do it not because I need the job, but because I want to work with him. I love him, he's an amazing surgeon. Yeah, but working one day a week in a practice is a it's a big challenge because a lot of prosthetic procedures require multiple visits, like a denture requires multiple visits. Yeah, well, this one patient came to us, and I've consulted with her on one of my Mondays down in the practice. And it was two Mondays before Memorial Day that I saw her. And keep in mind, Memorial Day is on a Monday. So this is two Mondays before Memorial Day, which means I only have one more Monday before Memorial Day. Oh, because you're only there once a week. Yeah. And because I'm only there once a week, I'm booked out many weeks in advance. Oh, I would imagine. Yeah. So she comes in and she says, yeah, I really want to have my mandibular arch surgery done before Memorial Day. And she had good reason for wanting that. Well, doesn't every patient have a good reason for wanting it? Absolutely. Keep in mind, we are living in the age, the dawn of Amazon Prime Instant. Yes. Exactly right. So we, as consumers are accustomed to now. Yeah. And so anyway, I told her, yeah, that's no big deal. We can do that. So we just booked her for a Friday when I would be off before Memorial Day. So I showed up and she was. She needed to have a maxillary complete denture made and a mandibular fixed conversion prosthesis. Mhm. So I went down there already knowing from her CBC data that she fit perfectly in a medium round arch form. And so one hour before her surgical procedure with the surgeon, I just took my medium round maxillary denture as if it was an impression tray. And I, I realigned it with putty. And then I realigned that with Light Body. PBS did all my muscle trimming, got my border molded final impression so that while my surgeon was reflecting or, you know, reflecting a flap and then placing the implants while he was doing that, I just went into the laboratory and did a quick laboratory, uh, realign or rebase of that denture so that by the time he had the implants in place and we used omnibus, my denture was ready to deliver and be used to pick up the mandibular stock denture and turn it into a conversion prosthesis. So it's, it's it's like wildly, wildly convenient to have these stock dentures. It's it blows my mind. But as a orthodontist, I never would have thought that it was possible. So I took my brother, who's an orthodontist. I asked him for access to his Etro scan data because he does post-op scans for all of his patients. Sure, I just do like 30 names at random. Right? And I start doing measurements on those 30 patients, and then I, I measured the medial lingual cusp of the first molar. To the contralateral media lingual cusp of the first molar. Then I measured from the cusp of the canine to the cusp of the contralateral canine, and then I measured the length of the central incisor embrasure. So between 8 and 9 that facial embrasure two the line that connects the medial lingual cusp tips to get an idea of arch length. And then I categorized the arch forms as either as either square tapered or ovoid. Yeah, the data was the data was so amazing. There was a deviation of about three millimeters in arch widths, which you know, that's the total width. So that's a hat 1.5mm on one side and 1.5mm on another. And that's the difference between small and large. Well no that was in the natural dentition. That was the deviation that I saw. Oh okay. So now I'm starting to get an appreciation for oh my gosh, look at how similarly sized these arch widths are. And then arch lengths again a deviation of about three millimeters. So even tooth size isn't different isn't deviating very much. Arch form. That one was the real shocker to me. They were all coming out with very similar arch forms, and I don't know much about orthodontics. That was a weakness in my education, right? Yeah. So I called my orthodontist brother up and I said, hey, Michael, what is going on here? Why do I see so many of your arches with the same arch form? And he said, Brandon, Brandon, think about forced them into that. Exactly. He made it that way. I only have one arch wire in my practice. Uh, those are all regular braces. Yeah. So he uses prescription brackets with arch wires, with prescription arch wires. And so pretty much all of his patients come out with a very similar arch form, rounded, I imagine. Yeah. Yeah. Yeah, I would imagine. Yeah. So now I ask him one of the dumbest questions I've ever asked. I said, you mean to tell me that you can meet your patient's aesthetic expectations with just one arch wire? And he said, Brandon, think about how these patients present to me. Yeah, well, that's a very good point. And so I thought, how do my patients present to me even worse off than his patients present? Yeah, right. So I needed to get out of that mentality of, no, everything has to be custom. There's no way you can meet a patient's aesthetic expectations with anything less than a custom prosthesis. So I put it to the test. Me and my technician during Covid. We designed these. We have a total of 18 dentures. So nine uppers, nine lowers. And there's three sizes small, medium, large and three arch forms a square, triangular and round. All the teeth are the same on all of them. No, no. We used Vita. Vita pen teeth. Yeah. And there are several tooth molds for them, depending on the size of the arch, depending on the size and the arch form. Yeah. Makes sense. Another dirty secret is ask any tooth doc denture tooth manufacturer. Yeah. Ask them which of their molds fit within the top 80% of their purchases. Oh, there's always a common one for everything. You're going to find three three molds account for 80% of their total sales. Yeah 100%. And one shade will take up a big portion of it too, right. And so it's the stock denture just yesterday. You don't always use a stock denture for the actual delivery. Like you're actually delivering the product that you used. Mhm. But you can use it as a jumpstart into getting to the final restoration. I've always said even a bad denture gives good information. And so that good information 100%. Yeah, just expedites care. Right. Yeah. So just yesterday I had a patient in my chair sent to me from the VA down in Fayetteville. Two months ago he had nasal polyp removal surgery, and now he has communication with his nasal cavity, and he is unintelligible. You cannot understand a word he says because of that communication with his nasal passage. He needs an obturator. Okay. Mhm. And I'm trying to understand this guy. I can't understand a word he's saying. And so they're asking me can you help him. And I said honestly I don't, I don't know. He's this sounds terrible. So I just grabbed a stock denture off the shelf. It was a maxillary medium round stock denture. Realigned it with putty, realigned it with light body. And then I spent maybe ten minutes in the laboratory contouring the palate. Yeah, the cameo surface of the palate so that it would truly resemble what the denture would be for him. I put it in his mouth and all of a sudden he sounds like night and day difference. He is. You can understand what he's saying. So as a diagnostic tool, I was able to use a stock denture to very quickly answer the question for those patients. Can you help us? So people laugh at the concept of a stock denture? But I'm telling you, it is a very, very powerful tool in a dental practice. Yeah. It's interesting. I mean, I came into this thinking, snap on, smile. What the hell are you doing, man? But, uh, no, a lot of that's making sense. Yeah. No, it's it's not a snap on smile. It still requires. It still requires the laboratory. Right. So I use the denture as an impression tray, and then I send it to my laboratory to rebase it. Well, the way I see it is, I've done smart denture conversions, and you don't always get the best results. No matter what happens, what you do, the bite is off. There's too much of an over yet and that's with custom made. So I mean the problems happen even with. Oh, totally. So totally. Yeah. And we all just say this. These are just temporary. Yeah. We will make it better later. Yeah. And that's a really good thing to point out. You know, just as a tip to anybody who's listening to this. Don't oversell your services at the time of surgery. What I do is I buy grace from my patients. I tell them at the time of surgery, I really have five objectives, but only four of them I'm going to hyper focus on because those are the only ones that require hyper focus at the time of surgery. The fifth one I can hyper focus after surgery. Yeah, so these priorities are one to keep you alive. Yeah. Your health. Yeah. And the patients? Pretty pretty much appreciate that idea. Yeah. And then two to keep you comfortable. Yeah. And they're like, yeah. That seems like a pretty high priority. Yeah. And then I say the third is to get you implants. The fourth is to make you teeth. Yeah. And the fifth is to make you teeth that you absolutely love. I love it, and it's so true. If you just help your patients, appreciate that everything that's going on at the time of surgery, there are so many more priorities than getting the teeth. Absolutely right. We're going to get to teeth. We're going to make them look good. But you might have some preferences for what we do at the time of surgery to what we do at the final restoration. Don't worry. There's a time for us to hyperfocus on that. It is not at surgery. Well, for me, when I first started doing these things and someone asked me, yo, how'd it go yesterday? I'm like, ah, you know, not great. Midline was off a little bit and the person looked at me and goes, did the patient wear it out? I'm like, yeah. Then it was a success. Exactly. And I'm like, yeah, you know what? You're right. Yeah, I can fix that mid-line later. Exactly. Doctor Kofod, we went way over on time, and I think we could know. Don't apologize. I'm into this. It's always great talking to you. And I love what you're doing. And I love. Just keep doing it, man. Just keep making it better. I'm waiting for 3.00. Yeah. I know you're probably wanting to take a break, but. No, no, no, actually we do have a 3.0 version coming out, but sort of a but it won't be for all links. It'll be for any implant restoration. So I love it. Well, when you're ready to talk about it, let's have you back. Awesome. I appreciate the invite. And Elvis is awesome, sir. It's always fun talking to you. Thank you so much. Absolutely. And we'll talk to you and probably see you soon. All right. Sounds good. See you. Yep. Have a good one. A big thanks to Doctor Kofod for joining Elvis on this delightful, and I must say, delightful conversation about implants and parts and pieces and screws and abutments and a whole bunch of other things that I'm glad I don't have to keep straight. Because as everybody knows, I'm a I'm ceramist and I only worry about the final restorations for interiors. But seriously, it sounds like you came up with some pretty amazing new additions to your workflow, and I bet it'll help. A ton of technicians and clinicians have better results. And it's also great that you're keeping the 2.0 parts at the same price. That's pretty sweet. It's huge. Yeah. It's nice. So everyone doing full arches or if you want to do full arches head over to smart on x.com to see all of the parts that he talked about. And to get a starter kit today. Do it. All right everybody, that's all we got for you. And we will talk to you next week. Hey have a great week. Bye. See ya. Is it smart or smart on X. Smart on X. Smart on x. Okay, good. I'm glad I got it. The views and opinions expressed on the voices from the Bench podcast are those of the guest, and do not necessarily reflect the official policy or position of the host or voices from the bench, LLC.