It's that time of year to start planning your year end equipment purchases John Wilson: Hello, my friends, John Wilson here and I have a question for you. Are you ready to finish this year strong? Well, hey, it's that time of year to start planning your year end equipment purchases. And I'm here to tell you that Ivaclare has really stepped up their game and is offering some of the most incredible deals on mills and furnaces here at Sunrise. We've certainly been impressed with Ivaclair's quality, but more importantly, how they've been a true partner to me and my laboratory. When you can invest in reliable technology and say, well, it's a no brainer, right? So if you've been thinking about your first mill or an upgrade, I certainly encourage you to reach out to them today. Elvis: And of course, we appreciate Ivaclar for their continued support. Welcome to Voices from the Bench, a dental laboratory podcast. Send us an email@infovoicesfromthebench.com and follow us on Facebook and Instagram. Barbara: Wow, what a letdown last night's boxing Greetings and welcome to episode 347 of Voices from the Bench. My name is Elvis. Barbara: My name is still Barbara. Elvis: Still Barbara. How you doing? Barbara: Good. I think you and I both stayed up way too late last night to watch that fight. That sucked. Elvis: Yeah, it was kind of disappointing. Barbara: Kind of. Elvis: I'm not a boxing fan. I think I saw more boxing last night than I have my whole life, but wow, what a letdown, huh? Huh? Yeah. Barbara: Well, I'll tell you what, if you watch the two females fight, they fought their asses off. That was crazy. I couldn't watch it, though. I don't like blood and I don't like cuts. And so I'd go back and forth and back and forth and back and forth and. Until it was over. Elvis: But yeah, at least the main event. I mean, I don't think you. Nothing happened. I mean, you barely had to watch somebody get punched. Barbara: I know. I was really expecting more from him, but. What? Elvis: Yeah, yeah, whatever. A lot of people made a lot of money. Barbara: No doubt. Elvis: Netflix probably had the most views they've ever had, so a win for at least some people. We're bringing back the last two shirts we were selling over the summer Barbara: So what's up? Elvis: Well, you know what? Back by popular demand and the demand of Barb. Barbara: I know. Thank you. Thank you. Elvis: Wanted these to come back. We're bringing back the last two shirts we were selling a few months ago over the summer. Can't remember. So we're bringing back both of them. One for removable and one for fixed. So the removable is uber popular. Just say no to brushing. And then it has a picture of the denture on it by Brittany Mitchell. And then the other one is don't pull out. But if you do, put an implant in it with a picture of, an implant and abutment. Barbara: Yep. Elvis: Done by Charlie, who we had on the podcast a while ago. Barbara: Yes, yes, yes. Elvis: So we're doing these for an extremely limited run, so there's a chance that you might have them before Christmas. I can't make any guarantees, you know, with the holidays. And we know how things are with shipping and everything, but hopefully you'll have a chance. So if you do want these. And enough people reached out after the last one sold that they wanted us to do them again, it took you, Barb, to get me to go ahead and do it. Barbara: And thank you because I'm going to get more. Elvis: Ah. well, you know, as long as you buy and are good on your word, we're happy. So. Yes. All right, so head over to any of our social media Pages or to voicesfromthebench.com shirts to order either one or, hell, why not both of them? And as always, remember that all of the profits go towards the foundation for Dental Laboratory Technology. You can get a ticket for Vision 21. Barb and I will both be there Barbara: All right. Elvis: Speaking of foundations, you see that they have released that you can get a ticket for Vision 21. Barbara: Yes, I did. Elvis: I'm super excited. Barbara: Yep. Elvis: To get back and see everybody. It's going to be a great show. So also check out nadl.org for the Vision 21. Barb and I will both be there, not recording, but just enjoying the industry. So this week I get to have a bunch of nerdy fun talking to Alan Banks from Guided Smiles. Now, unfortunately, or maybe fortunately, Barb. Speaker D: Yeah. Elvis: You had something going on and missed this overly deep dive into surgical guides and stackable bone reduction guides. Barbara: Ooh, that turns me on just hearing that. Alan Allen started Guided Smiles to help surgeons and labs design guides Elvis: Well, until we talk about the blood. Barbara: Yeah, I know. Elvis: If you can't take a couple people boxing, I don't think you could take a full arch bone reduction. That's a lot of blood. Barbara: Yeah, I know. Elvis: So Alan was a staple with the growth of Roe Dental lab in Independence, Ohio. During his time there, he got to see and use pretty much every software out there to plan and design guides. Wanting to take their services to the next level. Allen opened Guided Smiles across the street. Really? Just to dedicate doing guides for surgeons and also labs. Alan talks about how they utilize real guide and how he worked with them to streamline the workflow and how labs can now plan their own chrome guided smile. Barbara: Nice. Elvis: Now, I actually do a fair amount of surgical guides with Derby and I just recently started Using this real guide. And I can agree that it's a pretty great planning software with pretty nice, amazing support. I mean, they actually helped me on a weekend, which is pretty rare. Speaker D: Yeah, yeah. Elvis: So if you do any guides or you want to get into guides, don't take it from me. Take it from an expert. Alan Banks: I just wing it as I go on this show As we chat with Alan Banks. Voices from the bench, the interview. Speaker D: Are you going to start off with a question? Elvis: Yeah, something. Yeah. I don't know. I just wing it as I go. Speaker D: Yeah, winging it's good. Okay. Elvis: So far, I've been all right for a couple hundred episodes, so that's fine. Speaker D: I'm ready. Elvis: Cool. Alan Banks from ROE Dental talks about implant humor Super excited today to talk to a fellow implant nerd, Alan Banks from ROE Dental. But not ROE Dental anymore. I think we'll get into that. Alan. How are you, sir? Speaker D: Hey, Elvis. I'm doing real good. Thank you, fellow implant nerd. We started the implant geek squad together, didn't we? Elvis: Yeah, we should. It's an elite group, and we all get together and it's all just screws loose everywhere. Speaker D: So there's so many things to poke fun at. Right. I mean, is it hard? No, not hard. easy. Elvis: It is once you're into it. You know what I'm saying? It's like people that haven't even dipped their toe are so scared of the scope of it, I guess is a good way to put it. But once you get into it, it makes sense. Speaker D: It does. Once you get beyond reading the instructions. Elvis: You know there's instructions? Speaker D: Well, yeah. You know, when you. When you were a kid, your dad opened the box up and the first thing he did was grab the instructions. Right? That's the first thing he did. Elvis: Yeah. Speaker D: And then we, as participants in it, said, what are you doing reading the instructions. Well, I don't understand. There's only 57 bolts and a bunch of stuff. And you go from the beginning. But in implant world, you get beyond that. You're not opening up that little thing and reading the instructions. And because it's become for us, we've done it so much, we know what to do. Elvis: Yeah. Speaker D: You know, and the humor part of it is that you're right, people don't get it. And you have to make the announcement. That was dental humor. That was implant humor. And then everybody relaxes and they laugh because it was funny. Elvis: It was. That's hilarious. Speaker D: Yeah. Alan, you presented a three part series on basic dentistry basics Elvis: So, Alan, I mentioned at the beginning I know you from ROE dental, so I've been out there a few times. We even shot like, a video for locators. Speaker D: Right. Elvis: I was actually looking it up. It's funny. I want to mention this real quick. You guys turned it into a three part series. Part one, I was just looking at this. This is funny to me. Had a thousand views. Part two had 370. Part three had 2.3 thousand views. who skips and goes to part three? Speaker D: Ah. yeah. Remember how we talk about reading the instructions? Elvis: Everybody just clicked on the last link they saw. That's funny. Speaker D: Yeah, yeah, yeah. And, and you know, the thing is when you came and presented that, whatever that would. Maybe 55 minutes or something like that. Elvis: Yeah. Ah. Speaker D: For you and me, it was a powerful message about the simplest things in dentistry. But a lot of that stuff is just skipped over. The fundamentals of locators and parts. Elvis: Sure. Speaker D: How to use them, all that kind of stuff. It was so fascinating because you and I had a call about that before and I said, oh my God, yeah, you've got to come here and present this. And most people would say no, you don't just, you know, go experience at Chairside or something like that. But that's not the case. What you taught there was very valuable and built on that was me having ROE Dental Lab contact you for so many things. What implant is that? What part is that? What ball is that? That kind of thing. Right. Instructions, how to's. Yeah, we've had some good interactions on some of the basics that most people don't know about. Elvis: And that's what we call the nerd talk. Speaker D: Yeah, the nerd talk for sure. Roe Miller and Roe Dental lab is coming up on 100 years Elvis: So Alan, tell us your history. I know you're sort of family related to the Rose. Speaker D: Yes, the Rose. Well, the Ro. The Row passed away. The Row passed away a long time ago. That was Roe Miller and Roe Dental lab is coming up on 100 years. Elvis: Are you serious? Really? Speaker D: Yeah. Elvis: What year will be the 100 years? Speaker D: 26 real. Elvis: You guys going big, doing something huge. Speaker D: Yeah, I don't. It's a little ways away. You haven't talked about it really. And I think at one point I know that Mr. Kowalski, who is BJ's dad, said that this was maybe, maybe 15 years ago. He said this was row dental lab was the longest continuously operated laboratory in America. Elvis: Wow. Speaker D: And he bought it back in the late 70s, so he would know probably. Elvis: Yeah. Speaker D: So it's got some history. That's got some serious. Yeah. History. It's. It really only has two family owners, Ro and then Kowalski and then you know, BJ bought it in early 2000s. BJ's my brother in law. He And I went to college together. Elvis: There's the link. Speaker D: That's it? Yeah. And. And then I started, shortly after marriage. It was, It was a fight. You know, I. I tried to stay out, but I got pulled in. When I first started with Ro Dan Lab, I was doing outside sales Elvis: What did you do before? Speaker D: Lots of things. Mostly sales, because I. When I first started with Ro Dan Lab, I was, doing outside sales, writing the row reports, which was our quarterly newsletter, and then some minor things inside, but mostly outside. Elvis: Yeah. Speaker D: And then I just, like, you talked about. You geek out on some things, and you end up coming inside. And then that turned into more writing and R and D and then managing the salesforce, which was small, but then really going in more into R and D. And then focusing is only about five years in focusing on surgical guides and implant dentistry. Elvis: So where did you get your education? Was it all in the lab 100? Speaker D: Well, I wrote. I wrote the row reports in conjunction with BJ and his dad for years. And that was a deep dive into dentistry because, you know, it's a full service lab. So we wrote on everything, but my father in law insisted on empirical data before you put it in a newsletter. And so we would do some serious homework on every topic, and we would write it and rewrite it and rewrite it over and over again. Like old school. Like guest professor. I'll go rewrite that again. Elvis: Yeah. Speaker D: And we got it right. And that is how I learned dentistry, through those interactions. Elvis: That is a very intense way to learn it, because I imagine you had to communicate a lot with clinical in order to write those things. Speaker D: Had to. Had to research, had to work with doctors. And a lot of it was operative. You know, it wasn't all laboratory work. Elvis: Sure. Speaker D: How does. How does our product work in the chair? So that was a deep dive for years. And then it was. It was, you know, his old man, Kowalski, was relentless for perfection. And so it was a serious deep dive. And it was, you know, brainwashing into best practices for dentistry at the clinical and for lab technicians. It was a great education. Elvis: And this was a monthly newsletter. Speaker D: we did it quarterly. Elvis: Quarterly. Okay. You ever go back to look at the originals and see how they stack up? Speaker D: I kept them all. there's 32 years of it times four. 32 years times four. I have them all on a hard drive. And coincidentally, or maybe it's ironic. I don't know. Don't use the word irony unless you know what it means. Let's call it coincidence. Elvis: Yeah. Speaker D: Three weeks ago, we started RO Reports again. Elvis: Really? Speaker D: Yeah. And it's Been dead for, four years, dormant. Elvis: Why? Speaker D: Just because we wanted to do a newsletter. And I said, well, you're going to call it ROE Reports, because here we are writing it again, and here we are using. Instead of us creating the content, we're actually taking a row, is taking the. What they. What they believe to be are the hot topics in the marketplace. Summarizing them into a quick, row Reports and then a little deeper dive if you want to read more. And it's a bi weekly now. Oh, because there's so much content out there. Yeah, yeah. It's kind of. Kind of neat. That's kind of exciting, bringing back all. Elvis: Those articles about cap tech and, all those other, you know, impress. You're gonna bring those back. They're relevant today. Speaker D: So many topics, so many shades and twin class techniques and so many old things that we went over. My goodness, so many. So when did you get into surgical guides? We got involved in 2004 with ident Elvis: So when did you get into surgical guides? Speaker D: We got involved in, 2004 with ident. and that was way back when you had to take a ct. You know, a patient had to go to the hospital and get their entire torso and head scanned. Elvis: Really? Speaker D: Yeah. Back when you had to give them the gantry and the tilt and all these different, geometries for how you put a patient in and how you set the scanner. I had no Idea it was $1,000 to get a CT initially, until some of the hospitals started taking a simple head scan. So it was that long ago it was ident, and that was for years. We made them with identity, and then, and then we got involved with Simplant. Elvis: So how'd you make them if, you know, 3D printers weren't around or. Speaker D: Well, they were. Well, they were around. Remember, back then, there were two different types of ways to make guides. You could print them like. Like Simplant did and, like, ident, because IDENT was really the first one that was more open, more easy to use. And you weren't strapped by Simplant's protocol. Elvis: Sure. Speaker D: And we. We would design them and we would print. We had one of the first resin printers in the country, too. So we were printing here. Elvis: Wow. Speaker D: And the other technique was that gantry, whatever that thing was called. Maybe you put the little. It was almost like, three little knobs that you do an XYZ in a drill press. Remember that thing? Elvis: Kind of, if I'm thinking correctly, but it was. It was like a mill. Right? Speaker D: It was a mill. And we never got involved in that one. That seemed a little preposterous to Go from digital to gantry table with three axis milling back in 2005. So we just, we went with resin printing and putting titanium sleeves in it. Elvis: But that was early resin printing, right? I mean the industry really wasn't printing much else. Speaker D: No, no, there was. I don't know what else was being printed at that time. I don't remember anything. Yeah, no models. No models. We were fitting everything to stone casts. Elvis: What was the accuracy of these things? Speaker D: Pretty good. Yeah. I couldn't give you any numbers on it. We were pretty much only working with oral surgeons. Elvis: Yeah. Speaker D: In fact, it's kind of funny. Ah. An Irishman living in Israel flew here to Cleveland and met with us, just on a simple phone call. And we told every perio and surgeon in town that this guy was coming. And we have an alternative to simplant. And the room filled up. We had like 40 people here, 40 surgeons. And they all came in because they were totally curious about it. And that's who we were working with initially. Just specialists. And I can't tell you success or failure. I know it was successful. We kept at it. Elvis: Sure. If they came back for more, I. Speaker D: Mean, they came back for more. Elvis: Usually the sign in a dental lab, it's working. If they come back for more. Speaker D: Yeah. Everything back then was dual scan scan appliance, you know, and nobody had a cone beam. There were a couple of new tomes and actually Case Western University had a new tome in their ortho department and that's where they were sending patients that. Elvis: Replaced the CBCT in the hospital. Speaker D: That was. Yeah, because that could be focused just around the head for sure. Elvis: Interesting. Speaker D: Yeah. This giant machine looked like RoboCop times 10. It filled a room. I don't know if you ever seen a new tome scanner. Elvis: No, I haven't. Speaker D: $250,000 and it. And it was this giant arm that two arms that spun around and you could barely fit in a room. Elvis: And what was the quality of CBCT scan? Because some of the ones we see today are pretty damn good. Speaker D: The reason new to made its name is because it could take. And I don't even know if it was called cone beam back then. Yeah, it was just a CT scanner. It was very good. Even now I think arguably New tome is the best. Elvis: Hose is still around. Speaker D: Oh yeah, they're still around and they're still very expensive. They've kind of priced themselves out of the dental market. Elvis: Yeah. Speaker D: But they would give you the best resolution for years. We wanted something we could make guided smile in a few minutes Elvis: That's so interesting. And how many implants could you do with this system? All of them? Speaker D: Oh, yeah. Oh, oh, the imp. Well, ident. Kind of like you do with a Blue sky today. You could, you could just pick, diameter and length. It would give you a geometry. It wouldn't give you an implant. Elvis: Okay. So it wasn't specific. It wasn't like today that you needed the, the actual, I guess the DMEs for each implant and all that. Speaker D: Yeah. Well. And even now, Bluesky, if you want to make a generic, you just say, you know, 4.3 by 10. It gives you a cylinder if you want. Elvis: Yeah, yeah. Speaker D: We've moved to Real Guide for almost all of our cases because they partnered with implant companies all over the world. Elvis: Yeah. Speaker D: And they have the implant body, they have the parts. Actually for us, they really put a focus on the componentry, the multi unit abutments, the trajectories, the actual STL shape, which was really important to us for planting holes on prosthetics, you know, where nobody, nobody else was doing. Everybody else is using generic stuff or they wouldn't allow us to build something off a trajectory. Everything was built off the implant. And for us that was inaccurate. Elvis: Yeah, you needed it off the multi unit. Speaker D: You needed off the multi unit in the right trajectory. Yeah, that was key. That's key. Yeah. Elvis: So we'll get into Real Guide in a minute. But I imagine at RO you kind of went through all of them, right? I mean, you've probably seen them all. Speaker D: If you look at a timeline, it was, ident Blue sky three Shape Implant Studio Co Diagnostics and. And then a company out of, Ukraine, Implastation and one or two more dabbling. Sure, there are a couple more comes to mind. But then, and then finally, because the workhorse was Blue sky for, you know, a decade and we still use them for their implant and for some peculiar implant systems because you need a really generic way to just put platform and length and not fuss with anything else. We have to do that. But otherwise the workhorse now is real guide. Elvis: Yeah, I've heard great things about it. Speaker D: Yeah, it's a great software. It is. Elvis: So how does Chrome fit into all this? RO is pretty known for Chrome. Speaker D: Yeah. There is the crux in our decision making, which happened about two and a half years ago. We reached out to several of the top guided surgery companies and we had our list of things we want, our wish list. And at the top of that was we want to create guided smile in the software. So instead of exporting and doing mesh mixer type stuff for hours and put the kids to bed and work till midnight. We wanted something we could make guided smile in a few minutes in the software. As soon as we're done planning and nobody was interested in doing it, they, you know, raise an eyebrow. But they, I think they thought of that as being, you know, maybe outside of their interest and maybe outside of their scope. So that was our main thing, be able to make this, make this inside the software. But the other was that they would have OEM parts of all these companies and their part numbers and reporting based on all these part numbers and then have the actual DME STL files in the software that we could switch in and out instantly while we're planning and then while we're designing if needed. Elvis: That sounds like a pretty big wish list. Speaker D: Well, it took them a year to build it inside of Real Guide. There's a plug in now and you pay for it, it turns it on and as soon as you're done planning, poof, you go in. And if you just want, what we call a combi guide, which is bone reduction osteotomy, you're about 10, 11 minutes into it and you're kicking out STL files. Elvis: Explain the process. What do you mean by the whole smile? You want everything all within one software. The teeth, the everything? Speaker D: Yeah. Right. Now RealGuide has a way to do the entry point, which is files, do a setup, do the planning, bone reduction, it has the ability to do that. Currently we're using what really are better softwares at the time being, which are 3Shape and Exocad for tooth setup, smile design and all that. Yeah, you know, it's just building on a long history of being able to, you know, to perform that task. Right, Nice, nice software to do an ideal setup with all different tooth libraries. That's where we are, that's where the industry is. So we do that outside the software and then we import it and then after that we manage bone reduction, implant placement, multi unit, abutment temp cylinder, everything to get the case ready for the online meeting. And when we hang up, then we click a button and go into this guided smile design plugin. Elvis: Okay. You've designed pretty much the teeth on. Speaker D: Three shaper exocad for the time being. Yes. Correct. Elvis: Yeah. And you're importing that into Real Guide. Speaker D: Yes. Elvis: Planning the implants based upon tooth position, based upon bone and all that. And then it goes to that next step. Speaker D: Yes. And traditionally that next step is exporting and going into two or three different softwares for any number of things. Bone segmentation and Then product design. Elvis: Yeah. Speaker D: You know, you got to create those STL files. What, uh, real guides engineers calculated was between 500 and 800 clicks What, real guides engineers calculated was between 500 and 800 clicks. Elvis: Oh, geez. Speaker D: Over an hour and a half to two hours to design a guide. And anybody listening knows that when, like I said, when you. You put the kids to bed and go grab mesh mixer, you're up till midnight making a surgical guide. And everybody just nods and they're like, yeah, it sucks. Elvis: Yeah. Speaker D: So instead he said, he goes, I can get you down to about 45 to 60 clicks. And we're there with combiguide and then with guided smile, a few more than that, but not many. And it's fast. It's just incredible, really. We've made thousands of them now in this plugin of arches. Elvis: And how does it eliminate the clicks? I mean, the work still needs to get done. Is it just automated? Speaker D: Well, imagine you need to make an arc, right? An arc that connects a, sleeve to a base. You gotta make the base first, and you have to make the housing for the sleeve. Those are cylinders and platforms. So that was a bunch of clicks. Then you gotta make a simple arc to connect it to. Well, first you got to make a circle. You got to move it in the right place. Then you have to cut it, stretch it, and then you have to attach it to these two components. That's just one of maybe 40, 50 different parts you have to make to construct this structure, this digital structure. Lots of clicks just for one step, multiply that by all this other, and you're at 6 to 800 clicks. It's crazy. Elvis: That is crazy. Speaker D: And now you touch the bar, you touch the sleeve, you push it in the middle, you bend it to make it round, and you hit end. Yeah. Elvis: It took the geniuses at Real Guide to make this happen. Speaker D: Yeah. I don't know. Like I said, we petitioned all these other companies to do it. And the main engineer from Real Guide flew here from Italy and hung out with us for a couple of days. And he had one of those extra sketch pads with a pen m. And he just sat there like this brainiac engineer as he sat there and he made notes, watching somebody Design a regular FP3 single arch dente chrome case. And that's when he goes, I'll get you down to 60 clicks. Elvis: Really? Speaker D: Yeah. I'll be darned. He flew home the next day, and he called me 30 days later and gave me a demo. And he had made it about, you know, 70, 65, 70% of the way there. And I said, I'm sold. You know, and that's, we really, that's when we started making the partnership with him. The funny thing is before he flew over here, Real Guide, which is three dm, in order to sign a contract with us, their company had to investigate us. Right. Because we were claiming all these, you know, the patents. Right. I mean the reason we partner with somebody is because we have the patents and we help make them famous and their attorneys and everybody went dark for like three months and they investigated the patents, the claims against it or the petitions against it with USPTO and all this kind of stuff. They came back and said, all right, you guys are legit, let's start writing a contract. We're going to fly our engineer over there. And then it. And that's when it, that's when it went. Elvis: Yeah, you got legal involved and they muddled everything big time. Speaker D: Right. I mean they're owned by Zimvi, who's not going to mess around with a contract with somebody who's not legit. So that was one of the determining factors of us signing a contract with them. And then we spent about the next eight months back and forth so many times you wouldn't believe it with fixes and edits just to an FP3. And then we did FP1 and then we did tissue supported and double arch and all these different things to make it more, more and more and more and more efficient and accurate. Elvis: So the whole process didn't start with a like a simple tooth boring guide. You went all in deep the hard way first. Speaker D: This is real guide. So they had the ability already to make simple guides, tissue supported guides, bone supported guides. They were a well established surgery. Yeah. So they, they had that stuff all wrapped up. Their next mission was automated bone segmentation, root segmentation. They had these other visions and not really so much a full on stackable system like we had. It wasn't in their future that they, that, that I saw they were working on other things, but they already had all the other guide systems in their software. Elvis: Yeah. So I'm going to go back to Chrome again because honestly I know RO doesn't own Chrome. It's a separate business, right? Speaker D: well, maybe not. We just went through all these trademarks and registrations and all that Chrome Guided Smile is the brand and Guided Smile LLC is a separate company. Me, I'm the president of Guided Smile. So me and about 34 people left Roe Dental Lab. We were embedded in there for all those years. We left A couple years ago, and we went across the street and we started a whole new llc. Elvis: Interesting. Speaker D: Ah. We are a sub. What's it called? A, sub something or other. Elvis: Subcontractor. Speaker D: No. Well, we are kind of a subcontractor as a different llc, but we're separate. We're separated companies because our real goal is to support labs, work with labs. That's. That's our second biggest customer is labs out there in the. Well, it's our biggest customer labs. RO is one of our many laboratories that we work with. And it's just a lot easier for us to support any number of labs out in the country and not have to say we are inside of rodenta lab. Elvis: Makes sense. Yeah. Speaker D: Doesn't work. Guided Smile is now an independent company, so everything is done online That. Does not work, that relationship. So we're an independent company now. Elvis: Nice. Speaker D: Yeah. Elvis: Do you have a nicer building? Did you really do it up? Elvis: Rose. Pretty swanky. Speaker D: Yeah. Rose. Pretty nice. Yeah. you know, we kind of took the same values over here, so the place is very clean. Elvis: Yeah. Speaker D: And it's quiet. And because remember, here, all we're doing is online meetings, some fabrication, but we don't have the noise of a fully functioning laboratory. It's not the same noise. Elvis: Not a bunch of handpieces going on or anything. Speaker D: Right. Not the same volume of suction and evacuation. It's not the same. And we also. One of the neatest things is we became much more efficient because we're not sharing printers and mills. We're not sharing people and customer service, anything. Everything is contained over here. So a case that would take a week over there could be a day over here. Elvis: Yeah. Plus, I mean, you did so many things at row, I imagine you got pulled in every different direction 12 times a day. Speaker D: That was a problem. Elvis: Yeah, I bet. Speaker D: Yeah. It's taken me over a year and a half to just, you know. You know how it is. You leave a company and they're still calling you, asking you stuff. Elvis: Yeah, of course. Of course. Yeah. Speaker D: Yeah. Elvis: Okay. So again, I keep going back to Chrome because that's what I know so much of. So. Speaker D: Yeah. Elvis: Before you design Chrome with thousands of clicks, are you now doing Chrome with this workflow? Speaker D: All of it. Got rid of all of our other licenses, the fancy VR meshes. We were using whatever it's called. yeah, VR mesh. Not Mesh mixer. We were using Magics. We were using all this other software to get these cases done, and we were outsourcing bone segmentation that we didn't have time. Like, all these things. We were all these Licenses and stuff. Elvis: Now it's all this one simple, simpler to use real guide. Speaker D: Yeah, it's become so much simpler. And so it's allowed us to be more efficient, cost effective. I don't know, we still have to pay for all the real guide licenses and upgraded licenses to do it. But as far as labor, people, time, how long it takes, that's the real. Elvis: Oh yeah, 100%. Speaker D: Sounds like it's scale to scale. Well, and here's the other thing. This is, this is something we could not do before. Everything we did was designed here at Guided Smile. We, you know, if a lab sent us a case, there was no design option for that laboratory. None. We would do the planning, the design, most of the fabrication, put it in a box and send it to them. Maybe they would do some printing of, the pinning guide, you know, the carrier guide, the models. But for the most part, we did everything. Well, when we, when we developed the software, we also allowed our partner labs to do some or nearly all of the work. And we developed a whole chrome university. So if a lab wants to plan, design, fabricate, they go through university, it's all online. They graduate, they complete a case and ship it to us and prove they can do it. And then they really take control and ownership of their cases on their timeline. You know, they don't have to wait for us, they don't wait for shipping, except for metal and a couple of things like chrome locks, that kind of thing that we make the metal here and we make some of the componentry that's required, required, but otherwise they can go as fast and efficiently as they want to and not wait for us. And they could be much more profitable because they're not outsourcing everything to us. Elvis: See, this is interesting. So a lab, either they're already doing their own guides or they want to get into guides. What's the investment? Do they have to buy the real guide? Speaker D: Yeah, but we made a deal with Real guide where they can have the least expensive annual license of real guide, which is called the digital doc. Yeah, it's 500. I can put pricing on here, right? Elvis: Yeah. You're fine. Yeah, yeah. Speaker D: So it's $559 a year for the real guide license. The first year they give you 50 clicks, which equals $585 worth of clicks. So they basically pay you to get their license. Kind of fun. Elvis: So the clicks are exporting of the. Speaker D: Guide, Regular guides, not, not guided, small guides, they give you these free clicks for a two supported guide, something like that. So that pays for itself. So once you have that and you've gone through university and graduated from this, we call it Design 101. It doesn't teach you how to place implants or plan implants, that kind of thing. In America the only metal printing right now is for partial frames That's, that's a little bit more involved but it will teach you when you're hang up with the doctor. I like the implant positions. Then you go through the plugin and that's what this design university teaches. They graduate and then they have. There's an annual license to do Guided smile which is $900 a year. Speaker D: To do Goddess Smile. And if, you know, we could always have a chat with the lab about that. You know, depending on their kind of volume, what they're going to do. We talk, we talk. That kind of thing. Yeah, but that's the price tag. And then they just pay per click to export the files and be able to get the files and nest them on their own site and receive the medal in the mail. There's a whole fee schedule for who does what. You know, if for instance a lab might want to plan implants and design but they don't print metal and they may not even make ah, printed prosthetics. So maybe they're outsourcing some of this stuff to us. Elvis: Yeah. Speaker D: So it's all a la carte. Depending on what they. We call it Meet you where you are. If you're capable of doing everything, we'll give you all the files and ship you the metal. If you're not, then pick what you want us to make. Elvis: But you have to have a metal printer or can you mill it? Yeah. Speaker D: And really there aren't any. Not for Chrome Guided Smile yet. I know there's a couple of companies out there trying for partner lab but in America the only metal printing right now is for partial frames. And that's a way different animal than printing a fixation base and an osteotomy guide. It's taken us how far are we now? Elvis: That long? Speaker D: Five months into printing metal and we just had actually had a meeting this morning and we're finally now at A as in grade A as opposed to C plus to B minus. Elvis: Oh, I don't know what it indicates but it's got to be good. Speaker D: Well, I mean we, we got some serious standards obviously. Right? Elvis: Sure. Speaker D: And C plus or B minus gets rejected until it gets sent to us in an A. We need an A every single time. So there's two. There are too many B minuses coming through that have to get Remade. And right now we're at the point where just about everything is in a. And it's taken us that long to do it. I mean, we're talking thousand arches we printed probably 2,000 arches of metal we printed. And it's taken. So I guess it's just a little bit of a warning, to somebody who's thinking about buying a metal printer. they're pretty easy to get involved with partial frames because there is precedent for it. There's rules for it based on which printer you buy. You know, there's a. There's a protocol that works for a partial denture. There is no protocol for a fixation base and an osteotomy guide because there's. I don't know. Have you ever seen metal printing? Elvis: Oh, yeah, we. We have them at Derby. Yeah. Speaker D: Oh, you do? So you know the process of nesting, firing, despruing. Elvis: Yeah. It's not. I was shocked when I learned how much had to be done after it printed. Speaker D: Crazy, right? Elvis: I was like. I thought it was done when it was printed. Speaker D: Nope, it's not. Because. Because it comes off the printer and you have all that tension built up in the partial frame. Elvis: Yeah. Speaker D: And ah. Then you have to fire it to reorganize all the molecules to get rid of the tension. Then desprue. And then look at the thing. I mean, it looks like. It looks like something out of, 20,000 leagues under the Sea. It's a mess. Elvis: It is a mess. Yeah. Speaker D: And then you got to go make it pretty, which is a lot of hand work or acid bath or maybe a D light Belmont type machine. Elvis: I think we have an electro polisher. I think. Yeah. Speaker D: yeah, electro polisher. But there's. There's a few different ways to get it to final polish. And it usually involves a lot of manual, labor at the bench. Elvis: Yeah. Speaker D: That's crazy. That's a system. But to, bring in metal printing for. For chrome, which also is FDA cleared using specific machine specific powders in a process. Elvis: So you're printing it there across the street from row. Speaker D: Yeah, yeah. Elvis: And that's. I would imagine 99.9% of the people that do this process have you print the metal. But they are probably, what, printing that immediate, load temporary in their lab. Speaker D: Yeah. If, let's say a lab is going to do everything except metal. What if a lab does guides but they don't do full arch bone reduction We ship them metal and the little chrome locks to attach all the stackable componentry M. And we send them the files, which are prosthesis, the second prosthesis, the rapid appliance so that's one material. And then they'll use, med610 for the pin guide and the carrier guide. And then they'll print all the models and then articulate and go through model surgery and all that. We train them how to do that, but that would be the lab doing a bunch of it. Elvis: So what if. What if a lab does guides, but they don't do full arch bone reduction, stackable guides? Is that something that you'll teach a lab how to communicate with a doctor on? Speaker D: Well, that's what. That's what I was saying. That's kind of the. That's the tricky part. Elvis: Yeah. Speaker D: Because knowing implant positions, bone reduction, smile analysis, transition lines, transition zones, prosthetic thickness during planning meetings, implant angulations, restrictions, exit point. I mean, there's like, so many things to do. We don't teach that part of it might be. Yeah, that's. That's the road or the, the guy to smile secret sauce. But, it's just so involved. We don't teach it. That's like an ongoing continuum. Elvis: Sure. Speaker D: We have nine people who plan all of our cases, and they all plan pretty much as a team. They learn as a team, they work together as a team. We have all these rules that we follow. Follow that have led to successful. I mean, we're at 27, 000 arches now. Most of that is with the same original team, and it's tough to teach. Elvis: Yeah. Speaker D: When we hire somebody, they spend a couple weeks here just sitting with our planners learning how to put these implants in the right position based on all these rules. Because, you know, one of them is, you know, single arch dentate. Fine. Not. Not terribly difficult. Lots of rules. But. But then you have all these FP1 natural implant placement positions. And then you have all these varying, varying situations. You got pterygoid, zygoma and nasalis. You also have, you know, gummy smiles. You have all these patients with no bone. Oh, yeah, almost. And you got to be creative with it. Then you have to learn the nuances of it. When you're in the meeting with the doctor, you have to be comfortable saying, whoa, whoa. Can't do that. Based on. Based on what? Based on what we know. Don't do that. Elvis: Yeah, I play in quite a few guides, and I'm all, If the doctors want it, they're signing off on it. Speaker D: Yeah. Elvis: Okay. Speaker D: Yeah, but kind of like you, after a lot of experience with a particular thing, you're going to say, you know. Yeah. yeah, because we tend to we don't throw it around loosely, but we do throw around the F word, which is fail, which is fail. And so we carefully use that word because if they fail, we fail. Elvis: Oh, 100%. Speaker D: So it's okay to talk about it. Elvis: So can a lab use you to talk to the doctor, to plan? Can they just kind of pass through? Speaker D: That's the beauty of it. We are. Because we're separate, because we're a separate company. We have a whole neutral site, guidedsmile.com and on there it says join a meeting. And on there you'll click. One of our planners and the laboratory partner will coordinate that meeting with their doctor. They'll both join. Maybe it's the doctor, the surgeon, the lab, they all join with one of my team members in planning. And it's all, it's just everything that comes out of our mouth is guided smile. Elvis: Yeah. Speaker D: Neutral party. And it's pretty easy to do. I mean, we do that all day. Elvis: And do you charge for that initial service? Because I can't, I can't imagine. Yeah, you would have to. How many people don't go through with it? Speaker D: yeah, it's part of the case. Well, we have a, an evaluation as well. If a lab or a doctor wants to send a case here to just have the case evaluated. Is there enough bone for implants? Give me, give me a, just a, you know, 100 foot view of what you think of this case. We have a fee for that. If they want to do a full workup setup, bone reduction, transition line analysis, all that kind of stuff. There's another fee, so two different levels. We try not to get too far into the case before realizing there's an issue. Elvis: Yeah. What is your percentage of people that actually start and finish bone reduction surgery What is your percentage of people that actually start and finish? Speaker D: Oh, I mean, very, very high. Elvis: Is it? Yeah. Speaker D: Oh, yeah. The cases that get all the way to. We don't have enough bone are very low. Doctors who do this full arch stuff, they've taken a ct, they've looked at it, they got a pretty good idea that the case is going to go forward. They have already taken a down payment from the patient or maybe even got paid in full. Elvis: Sure. Speaker D: Then they're submitting their records. It's pretty rare these days where we're where the doctor calls and says, patient didn't give me any, they didn't pay for anything. And here I am with a guided smile case on my desk. Pretty rare. Elvis: Yeah. Speaker D: That's like once bitten, twice shy. Elvis: Sure. How many of them do you talk to that have never done Bone reduction before, it's got to be pretty common with gps. Speaker D: Had a conversation this morning. What we find is that most of our first time conversations, the doctors, they have some experience with denture conversions or they have some experience with delayed load, that type of thing. Yeah, I can't give any numbers, but it's less common than it used to be. Where they're asking, you know, what tools do I use to reduce bone? I've never done it before. That's pretty rare these days. Elvis: Yeah, yeah, but I mean there's got to be a lot of them out there that need a case, has a case that need to have the bone reduced, but they don't want to do it without a guide. I don't blame them. Speaker D: Yeah. Well, I can tell you that the guided smile philosophy has always been open book. And if you go to guidedsmile.com or you just go on to YouTube and say, show me a guided smile surgery, you're going to see everything from a little bit of bone dusting to removing, you know, 8 millimeters of bone. Wow. Or more with bronchers or surgical saws or aggressive bone reduction burrs. I mean you, you name it, you'll see it on a guided smile video on YouTube. And so you kind of go in there with your eyes wide open and what this thing, what this looks like once the teeth are extracted. Elvis: Sure, yeah. What about printing the stackable guides? Is that even an option? Speaker D: Yeah, yeah, yeah, we, you know, I ah, held off for years. I did Elvis. I was trying to keep all this, kind of like what the patent calls for, you know, which is a metal stable type guide. And actually the patent says like metal. I don't mean to put it in a corner like that, but there's some fundamentals about our product and one of them is that the foundation guide, the fixation base, never touches bone. It's always floating labial buckle to the bone so that you don't have to worry about undercut when you're introducing it to the mouth. Elvis: Interesting. Speaker D: Okay, everybody else, if you have a lot of undercut, you reflect, you take the bone reduction guide, you stick it on the bone apical to the teeth and then you introduce some kind of delivery device. Speaker D: Well that's very difficult to do and a lot of times it's almost impossible with undercut. And how your bone segmentation rendered the surface of your bone, it's just not perfect. So ours floats outside the bone. It's completely held by pins in different trajectories and to do that. It's best to use metal. Otherwise you have to increase the volume of the, that fixation base for strength. And so when you make a plastic guide, it's, you know, 30% bigger than, a traditional chrome metal guide. Elvis: Oh, because it has to be thicker. Speaker D: Yeah, has to be thicker. A little bit more reflection, you definitely have a little bit of flex, especially on a terminal site where there's, you know, the pin stopped and you're still reducing in the posterior and you've got a cantilevered osteotomy guide back there. You got some flex. So you got a little bit of risk involved. But at this point, if a doctor or lab really wants to get involved in, in office manufacturing, it's available. You know, we can just send the files and let's let them manufacture. It's not common. Doctors don't want to print 12 items and glue, titanium cylinders in and go through simulated, simulated surgery back in their lab. It's just not productive. Elvis: Do you require a certain surgical resin or do you not care? Speaker D: Well, no, it's, in America, MED610 is the only resin FDA cleared for fabricating medical device. And there's one other one, it's not used much, but the accepted one is MED 610. Elvis: So all the companies out there selling surgical guide resin, none of that is cleared? Speaker D: Well, I think it's, it's usually Med610. Elvis: Oh, that's like an underlying name of it or. Speaker D: Yeah, that's the, that's still the formula. They might rename it or something, but it's. That's. The formula is what's in Med610 that I know of. I think even like if Stratasys is printing or if Sprint Ray or formlabs, it's basically med 610. Elvis: Okay, interesting. Speaker D: Yeah. None of these companies are selling a clear medical resin for surgical guide intention. That's not FDA cleared. There's no way. Elvis: Yeah, yeah, it'd be in pretty big trouble. Speaker D: Yeah. So a doctor and we've had, we've had a couple doctors fabricate their entire case. We, ship them the, the titanium sleeves for the fixation base for pinning. We might sell them the sleeves for their osteotomy guide or they may buy them from their implant rep and they put the whole thing together. But you don't see a lot of repeat orders on this stuff because it's so much work. Elvis: Yeah, it's those doctors that grew up building models that they enjoy doing it. Speaker D: Yeah, the ones that went to engineering School and then to dental school. Dental school, yeah. Elvis: So you brought up a good point. You can use OEM parts or third party parts. Speaker D: Yeah, yeah, yeah. And when we make. It's kind of a loaded question there. Elvis: Okay. Yeah. Speaker D: when we're making the osteotomy guides, almost all of our osteotomy sleeves are oem. Elvis: Okay. Some OEM sleeves from companies are inaccurate, we've found Speaker D: And we have partnerships with all these different companies and there are some companies that still for some reason don't make any. Elvis: Hm. Speaker D: And there's also companies that want to do sleeveless. And so we just have native metal. And we've also found some sleeves from companies are inaccurate. When you look at 100 of them, they're not. They're not all the same. Elvis: Oh, jeez. Speaker D: And so we don't. We don't use them. And some of them are very, very chintzy. They're, maybe they're titanium, but they're earth stainless steel. But they're. You could pinch. Yeah, you could pinch them. You could. They feel like aluminum. You could pinch them and squeeze them. And so you can't force it into a guide, otherwise it'll bend. Elvis: Oh, wow. Speaker D: In a lot of those cases, we just use native metal. We print the metal to be the sleeve and not to accept another sleeve inside of it. Elvis: So you make your own sleeves essentially. Speaker D: Built into the metal. Elvis: Oh, okay. Speaker D: Yeah, yeah. Elvis: That's interesting. Speaker D: I mean, at one point, I mean, if we look 10 years ago, the only sleeve we ever put in any guides was, Three Eyes Navigator sleeves. Elvis: Really? Speaker D: Yeah. Because of the notch and because it coordinated with their guided kit. All the rest of them were native metal. But a lot of companies want to have sleeves in it. A lot of them are color coordinated. A lot of them are very precise. Like Bio Horizons is very precise. And it's all color coordinated. You put them all. We put them all in there. And some doctors want neodent OEM sleeves. Some. So some of it's preference and some of it's just based on our experience. What's. What's better than. What's better than good, you know? Elvis: Yeah. Yeah. That's really interesting. I didn't realize so many OEM parts were kind of sketchy. Speaker D: Yeah, well, I won't. 60, 70% of our cases are still native metal Let me, Let me take. Elvis: You don't think they have names? Yeah, no. Speaker D: And I, and I. And I wouldn't. But it's. It's only some. Elvis: Sure. Speaker D: But. But it's. It's enough that we found that if we just make native. Because here, consider this. You make a metal, you make a metal Osteotomy guide. And then you take a sleeve and you wrap it in special glass glue and you stick it in the osteotomy guide. We'll turn that guide upside down and see how that sleeve fits inside of the sleeve. You'll find that it's not at the right trajectory unless somebody was carefully putting it in there. It's off. Just because. Just because nothing's perfect. You got glue and you got a. And you got something that's printed in metal. So you have to be very careful with how you place it in there. So that adds an element of error. and then you go open one of these kits and you, you put a key or a spoon inside of their sleeve. That's losing. And then you put a drill inside of that. Elvis: Yeah. Speaker D: You might be 4 or 5 degrees separation from what the catalog told you it should. Elvis: But since the sleeve is printed part of the metal, you have eliminated a majority of that. Speaker D: Yeah, a lot of it. Elvis: That's really interesting. Speaker D: Yeah. And probably say 60, 70% of our cases are still native metal. Yeah, that's for metal. For chrome. For chrome guides. If it's a plastic guide, they almost all have a metal sleeve. You know, there's a couple companies out there who only do sleeveless hyacinth Mega gen. They don't even want you to put a sleeve in it. Which makes sense. Elvis: Does it make sense, though? Speaker D: Well, it makes sense for them because they have a keyless kit and because their system, they've been doing that for years. Years and years. Right. So they know it works. We know it works. Elvis: Yeah. Speaker D: Yeah. And there's no point in putting a sleeve inside of it if their master barrel on their sleeve is either going to fit in their sleeve, which I could tell you more about those sleeves, but I won't. I just find that it's, better fitting in the native. Native plastic or native metal fits. Elvis: Interesting. Speaker D: Yeah. Which is their recommendation anyway. So we do. Elvis: I mean, if it works, it works. So even with full arch stackables, if it's like a hyosin, you're going sleeveless. Speaker D: Oh, yeah. Always have. Always. And Megagen does make a sleeve, you know, and they say, hey, you can use a sleeve. But when you kick something out of their software, the R2 gate software, there's no sleeve. It's just pure plastic or. Well, they just use plastic. So it's just, drilling inside the plastic, which is perfectly fine. Because there's no cutting edge on those keyless kits. There's no cutting edge. You're Just a barrel spinning in a sleeve. Elvis: Yeah. Speaker D: The only thing you have to really be careful of is heat. Elvis: Oh yeah. You'll melt the plastic. Speaker D: Yeah, yeah, that's right. You can melt the plastic. You could also, because of that friction, you can give yourself a false sense of torque. You know, when you either when you put the implant in or when you're, when you're drilling, you might get a false reading because I mean, let's face it, you're not always drilling into a flat surface. You know, you're torque, you're torquing against a wall of a root and you're being pulled in a direction. Then all of a sudden you're hitting on the side of the sleeve and you're creating heat or some problem. But there we go, geeking out again. Elvis: Yeah, yeah, no, I, I love it. With guided surgery a lot of the implant placements are actual rotation So I know with guided surgery a lot of the implant placements, not just depth and angle, but it's actual rotation. Speaker D: Yeah. Elvis: Do you worry about that with full arch? Because you're going to put a multi unit on it. Speaker D: Yeah, yeah. Elvis: You have to, right? Speaker D: You do. And just a little, a little ditty on that. That's one of the reasons, for instance, the navigator, they had for forever, they had the best rotational control using their OEM sleeve. A notch. Once you get a notch over to a square, you're done. Well, if we have an angled site, we put these little nubs. They're all built into the software based on the angulation, the bend of the implant. Speaker D: We've got some seriously good education on indexing implants. But the idea is you rotate, you rotate slowly. You don't go back, you don't go forward forth. You just as soon as your barrel and your mount hits our guide, you should be stopped at one of the nubs, which is very doable. And then you just remove the mount and you're in, you're at the right rotation. But that's only for angled. The straight ones, we don't put rotational indexing in there. So only the angled ones. But I always recommend to stop with the flat or the bevel facial because if you ever have to come back and you're, you're in the number, you know, 8, 9, 10 position. 79, 10 position. Yeah. And you got to put a 17 degree or 30 degree abutment in there. Someday because class changed or because, you know, you wanted to move some teeth around, you might be stuck with a screw access that can only be put in a incisal edge because you didn't rotate the implant for the bend to be labial, lingual, your mesial distal bend. Elvis: Yep, yep. So you always stop that implant in the position where you can add a 17 degree at some point? Speaker D: Yes, for sure. Elvis: And what, there's dots on the guide and then there's what, dots on your drill? Yeah. Speaker D: There won't be any dots on the guide because we won't control rotation. But we will put. If there's a sleeve insert, we'll put the notch facial or on the mount. There's, almost always a hex, some indicator that says here's the flat side or here's the side that you stop rotating. Elvis: Oh. Speaker D: based on how the multi unit above it goes in the mouth. Right. Because sometimes it's a bevel, sometimes it's a flat. You got to know the system. Elvis: Interesting. Gosh. Speaker D: Yeah. Elvis: I barely grasp it. I can't imagine what most of our listeners are going through right now. Speaker D: We just need to get you in a bloody surgery, Elvis. Elvis: I've been in plenty of bloody surgery. I've just never been. Speaker D: I mean, a prone. Elvis: Yeah. I've been in a stackable one. I've never. Speaker D: Yeah. Elvis: I've never had to make one. I've never sat with one. One. I find them fascinating, but I also know they're. They're pretty pricey. Speaker D: Yeah. Elvis: Compared to freehanding it, you know. Speaker D: Yeah. Well, depends on where your costs are, right? Elvis: Yeah. Speaker D: Because if you're. If your costs are up front, then you know, your implants are in the right position. You got your AP spread, you got your exit points in the right places of the teeth. You're at the right depth, you planned the right transition, the right prosthetic space. I mean, I can go on and on, but, if the money is up in the front, then in the back, you're not trying to fix things later because of any number of things. Oh, a hundred percent that can go wrong. sure, I'll knock freehand all day, but that's still probably 80% of the market. It works. It's fine. But if you come. Come over to the lab sometime and look at these cases coming back in, in four or five months, if you stop by, I'll show you the shelf of guided smile cases, and then I'll show you the shelf of freehand. Tell me which one you want because it's different. It's kind of drastically different where the holes are. Elvis: Oh, no, I've witnessed lots of freehand. Speaker D: I mean, you know. Elvis: Yeah. Speaker D: You know, as good as anybody, you know. Elvis: You know how many Times I've done a case and when we do the final we need to change multi units. That adds up. Speaker D: How about custom multi unit abutments? Elvis: Yeah, that's a whole new thing right now. Speaker D: They're not terribly pricey, but they are pain in the ass to have to swap out in the middle of restorative protocols. Sure it's a great product, but why use it, you know, plan it right in the first place. Are there any plans that you do that require a custom multi unit Elvis: Are there any plans that you do that require a custom multi unit? Speaker D: Rare. Yeah, maybe it would be where they said hey, what if we put an implant here? And he said you could but you know. Yeah, you have to be creative on the restore sort of part, you know. And. And a lot of this stuff can now be fixed with angled screw channel. Elvis: Yep. Speaker D: That's really tidying up a lot of these screw accesses. But it's not really mainstream yet and it probably should be. Should probably getting. Be getting involved with an implant system that offers it or a third party component. Ti base. M angled screw channel system. Probably should do that because it's pretty stark. The difference between rotating something or you know, changing the trajectory just 5 or 10 degrees. It's really pretty amazing what you can do with it these days. Elvis: Yeah, but you're not delivering these immediate loads with ti bases, are you? Speaker D: Oh no, no. This is just transition to final. You're like just deal with it until the final restoration. I mean I know some of this in office printing you're doing with special screws in your. Speaker D: Change in angulation. If you're printing and delivering on the day of surgery or next day, something like that. But not for guided smile because we don't need to. Elvis: It's already there. Speaker D: Yeah, we've already put the screw hole in the right place. Elvis: So when you do the guided surgery, you're not picking anything up. That thing just screws in. Speaker D: Oh no, no, no, no, not, not yet. This is not driving a piston through an engine. This is. You're still having little bit of variation of where the implant was planned to where it's going. You know, it's still a guide. And then the prosthesis has six holes. Six temp cylinders are coming up through them. Elvis: M. Oh, you still have to do that? Speaker D: Oh gosh. Yeah. I think a couple of companies tried it in the past. I think Nobel tried it with the Noble guide. Elvis: Yeah. Speaker D: You know, you know, 10, 12 years ago, but just could not, no offense to them, nobody can do it. But you can't just piston drive an Implant in the mouth by hand, by a human and then expect that pre made screw to go in the same place. It's just not there yet. Even some of this new robotics and GPS systems, they're boasting some pretty good numbers. But not for six screw tolerance all lining up at the same time. Elvis: Interesting. I really thought these things just screwed right on because everything was so precision fit. Speaker D: No, no, no, no. I don't think any. I've seen it online, you know. Elvis: Well, it must be real. Speaker D: Yeah, it's got to be real. It happened somewhere. It's happened somewhere in Europe. There's no geotracking to the exact location, but it happened. I saw it on TikTok. Elvis: Yeah, TikTok. What about using a stackable guide and then getting into photogrammetry and then printing that thing after the implants are placed. Is that even a workflow? Speaker D: Yeah, yeah, that's. That's kind of a hot thing right now. In my mind ideal means ideal prosthesis And that's for the diy. We make a bunch of these combi guides where just like you said, reduce, put the implants in, put the muas on and then use photogrammetry or grammetry. Elvis: Yep. Speaker D: We designed some of these scan bodies that you can just screw on and scan. Elvis: Yeah. Speaker D: Pretty easily. Yep. Fiducial markers. Actually our fixation base can be used as a fiducial marker. We air abrade it, right? Elvis: Yep. Speaker D: And make it so it's dull and not shiny. And you can use that as a fiducial marker and then you can send it to a lab. You can get your file in an hour and then seed it that day or the next day. Elvis: To me, that would be the ideal situation. Speaker D: Well, let me, let me. You want me to compare and contrast the two real quick? Elvis: Yeah, yeah. Speaker D: Because it's ideal. Okay. I guess the, the category is what is ideal. Ideal means that you would be able. Elvis: To me not having to mix acrylic chair side. Speaker D: Well, but this is, this is just pop the top off and squirt. Because almost nobody's mixing acrylic. Because I get that you don't want to do that. You want to just squirt something in there like stellar or ah, voco. But in my mind ideal means ideal prosthesis. And if you are capturing the records and the lab is designing a. Basically a final hybrid design and you're printing, cleaning, curing, beautifying, seating that afternoon or the next morning, it's a pretty nice prosthesis. Yeah, but that was what I just mentioned. There was at least Four hours. And people listening will shake their head and say, no, it's not. It is because it's an hour. It's, it's somewhere between 25 minutes an hour to get your file back from whomever is designing. for the most part, I mean, if you got some if you got some guy in the basement, maybe you're 22 minutes. Okay. Yeah, yeah, but you got the file back, then you gotta nest it, cure it, clean it, cure it, beautify it. Well, that's a couple of hours. Elvis: You know, depends how beautifying you get it. Speaker D: That's true. And most of them are not beautified. Elvis: No, they're not. Speaker D: No. So that's not, that's not it. Not ideal. I'd question some of the materials out there, but I don't want to get into that because that's contentious. But then are you really having the patient hang out in that chair for three hours to screw it in or are you having them back the next morning to screw it in or the next morning after that? That's not ideal. Elvis: Yeah. Speaker D: And with Guided Smile, if I can just do a plug. Elvis: Yeah, please. Speaker D: I'm just kidding. You backfill the gap between the temp cylinders and the prosthesis, you adjust a little bit of metal back in the lab for maybe 12 to 15 minutes and you screw it in the mouth and the patient goes home. Yeah, I mean, I mean that's ideal. Elvis: And it's already pink, it's already tooth colored. Speaker D: It's, it's beautiful. Elvis: Yeah. Speaker D: Some of these, I mean, if you ever follow any of these cases that we do, they're just beautiful. I mean, they look like a final prosthesis on the day of surgery and off they go. They don't come back and get numbed up the next day and take out the healing collars and screw into prosthesis, you know, so I don't know. And there's still a lot of costs associated with all of that. That in house manufacturing, you know, people, especially people. But materials, equipment, chair time, I don't know. Yeah, I'll dog it a little. Even though we support it, I'll dog it a little. Because I think as far as ideal and speed and time and chair side and all that kind of stuff, Guided Smile is just so much more efficient. Elvis: What about Smart Denture conversion? Can you do that on top of it? I don't see why you couldn't. Speaker D: Smart Denture conversion is a really nice product and you could do that. Yeah. Be very quick too, right. Just. Just like a denture. Put them on, snap it off, drill your holes, deliver. Yeah. Elvis: Don't deal with the temp cylinders. That's what I hate. Speaker D: Yeah, I don't know. I've done both. Yeah, we even have this C2F. We call it a conversion to final, where we've invented a hollow analog. And you take the prosthesis that you pick up really quickly out of the mouth. The second prosthesis, you go back to the lab and you put these special abutments and mua heads on it. You make a model in a few minutes. And then you put the other prosthesis, the wear home prosthesis, on the model, and you drill this little 2.8 millimeter hole through the prosthesis. And then you pick up the copings back in the lab, and the patient's just sitting there, sutured. Wait. Waiting for it. Elvis: Interesting. Speaker D: And 30 minutes later, you're delivering something that looks like a smart denture conversion. Elvis: Yeah, just a scre. Elvis: Alan, we went way over an hour discussing guided surgery Access hole. Yeah. Speaker D: Yeah. Yep. Yep. Elvis: Alan, fascinating stuff, man. We went way over an hour. Barb wasn't around to tell me to wrap it up. Speaker D: Well, we did. Oh, we did. Look at that. Well, we only have 12 more questions to go. Elvis: You think there's a lesson? Speaker D: Yeah. Elvis: So, Alan, what's that website again? Speaker D: Guidedsmile.com. Elvis: Guided smile.com. cool. Everyone, if you want to check it out, you want to get into guided surgery, and you have no idea how to do it, which would be myself. Check it out, Alan. Thank you so much, sir. Speaker D: Thanks, Elvis. You're doing a good thing for the dentist. For the technician, you're doing a good thing. Nice work. Elvis: No, I appreciate that. See you in Chicago next year. Speaker D: Yes, sir. No IDs. You going ids? Elvis: Oh, I am. We are going to ids. The podcast will be there. Yeah. Speaker D: Oh, well, we're sitting nice. Can we do it in German? Elvis: Yes. Speaker D: that's fun. I'll see you later, buddy. Elvis: All right, thanks, Alan. We'll talk to you later. Speaker D: Bye. Alan Banks talked about implant planning on the Voices from the Bench podcast Barbara: A, huge thanks to Alan Banks for coming on our podcast and entertaining Elvis, which is pretty easy to do with all that implant planning talk. I'm really sorry I missed it. You know how I roll with implants and all of that stuff. But after listening, I did learn a lot about doing stackable surgical guides with all the full arches going on in dentistry right now. Guys, it's better to plan ahead than to fix your mistakes later. So head over to guidedsmiles.com to learn more about how you can offer this service to all your doctors. And on the weekends. Elvis: And on the weekends. Barbara: Yeah, it's good stuff. Elvis: All right, everybody, that's all we got for you. Barbara: Have a great week. Speaker D: Great. Elvis: Bye. I guess for $20 million, I'd let some guy half punch me for 16 minutes. M 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.